Show Summary Details
Page of

(p. 122) In My Voice: Speaking Out About Mental Health and Stigma 

(p. 122) In My Voice: Speaking Out About Mental Health and Stigma
Chapter:
(p. 122) In My Voice: Speaking Out About Mental Health and Stigma
Author(s):

Jeffrey Liew

DOI:
10.1093/med:psych/9780195320268.003.0005
Page of

date: 15 December 2019

Finding A Voice

I entered this world knowing how it felt to be alone and misunderstood. Born with a cleft palate, I had corrective surgery shortly after my first birthday. I do not remember many details from this traumatic event; perhaps I was too young—and perhaps our minds protect us from what we are not ready to handle. After the operation, I remained at the hospital for several days. My parents visited, but when evening came and visiting hours were over, they had to leave me. I imagine that I must have felt alone in darkness. After the corrective surgery, as I gained expressive language, I spoke with a minor impediment. Many people found that it took extra effort to understand me. To avoid unusual reactions or ridicule, I often kept silent as a young child. With treatment and intervention, my speech improved, but I had already known the pain and shame associated with making my voice heard. So I remained silent. It took years before I realized the distinct value of speaking in my voice rather than echoing the voices of everyone else.

With my voice, I now speak of my mother’s experiences with mood disorder. I am honored that she has granted me permission to speak for her in hopes that we will live in a society in which individuals touched by mental illness could share their experiences without shame and be heard with compassion and understanding.

Braving a Whole New World

I was 6 years old when my mother gave birth to my sister. My baby sister ushered in a world of change within our home. But the world outside the walls of our home soon began changing, as well. One year later, our family moved from Hong Kong to the United States. In addition to caring for my baby sister, my parents busily prepared for our major migration. We were uprooting and (p. 123) starting over. Imagining myself boarding an airplane and jetting across the world for the very first time, I was bursting with excitement. My father’s mother (my grandmother) lived in Brooklyn, and she periodically sent packages with audiotapes and photographs. On the tapes my grandmother described how we would go pick big red apples from tall trees in gigantic green orchards near Long Island. Luckily, she sent photographs, because such images were beyond the imagination of a child who knew only the hustle and bustle of an industrial city such as Hong Kong.

My grandmother also cautioned us about the extreme winters in New York. Accustomed to living in the subtropical climate of Hong Kong, my mother preferred to avoid the cold of New York by settling in San Francisco. Famous for the magnificent Golden Gate Bridge, San Francisco was equally well known for earthquakes, fog, and rain. However, I could never have foreseen that my family would be shaken to the core and weather the darkest of storms.

Without familial or social connections in the Bay Area, my father luckily found work as a waiter in Chinatown. As he toiled tirelessly until midnight, my mother juggled child-rearing and household duties. I remember her as able to handle everything. With my baby sister swaddled on her back and towing heavy bags full of groceries in both hands, my mother would lead my younger brother and me home from school. After trekking home, she always had after-school snacks prepared for us and would tutor us on homework for about 2 hours.

She always kept a Chinese-English dictionary nearby because her English was proficient but not fluent. After homework, my brother and I were allowed to watch our favorite television shows while a flurry of sounds filled our home. Chopping, the clanging of pots and pans, and hot oil exploding and crackling in the wok alerted us that we would soon need to turn off the television for dinner. My father’s work schedule rarely allowed us to have dinner as an entire family. When my father was home, he was in desperate need of rest.

The Scream: First Episode of Major Depression

Managing two rambunctious sons and a baby daughter in a foreign land must have been lonely and frustrating. On the surface, my mother was exhausted by the stress of family life and the transition to a new environment. Although that was part of the problem, explanations of life’s complexities are rarely as simple as they appear on the surface. Only 8 years old, I was blind to the internal turmoil broiling within her. But even at that age, I noticed that she was no longer herself. Instead of her usual strong and independent self, she displayed a lethargic, helpless, and hopeless side that I had never seen. One morning, I walked into the (p. 124) kitchen and noticed my father quietly hiding the knives and cleaver. How can Mom cook without her knives and cleaver, I wondered. Although my father was hesitant to alarm me, I sensed something was seriously wrong.

Later that afternoon, my 2-year-old sister napped while my brother and I watched our favorite television shows, just like any other day. After the show ended, I realized that nearly half an hour had passed since I had seen or heard from my mother. The usual sounds of chopping, pots clanging, and oil popping were missing. Instead, silence filled the home. Feeling panicked, I feverishly searched the rooms of the house. With no sign of my mother, I told my brother to stay with my sister while I frantically hurried down to the basement.

When I found my mother, I felt relieved. I saw her atop a chair, as she tied a rope around one of the wooden beams that ran across the ceiling of the basement. Suddenly, my relief at finding her turned into panic. In a matter-of-fact tone, my mother asked, “What would you do if I hung myself?” Immediately, I shouted for my brother to hurry downstairs. My mother began to position the noose near her chin and neck. Without a second to waste, I ordered my brother to help me grab our mother’s legs and to lift so we could support her weight. Knowing that we could not shoulder her weight for long, we started screaming for help.

Afraid that our noise would wake and frighten my sister, our mother asked us to stop. She cared about and thought of her children even in her darkest moments.

Instantaneously, I knew what I had to do. I screamed louder and louder until my mother shifted her weight onto the chair and then got her feet on solid ground.

After this incident, my grandmother moved from New York to live with us. Ironically, my grandmother’s arrival signaled my mother’s departure. My father told me that he was taking a short leave from work to go back to Hong Kong with our mother. I was sheltered from much of the chaos and details, leaving me with much uncertainty. I only knew that my parents were gone. Without our mother to pick us up after school, my brother and I now walked alone. Walking to and from school during days with heavy rain, I felt as if a mighty force was casting stones from the sky on me.

My siblings and I were careful to be well behaved for our grandmother so that my father would not need to worry about us. I knew that he had enough concerns with my mother. My grandmother had immigrated to the United States when I turned 1 year old, and I knew her only through photos, phone calls, and audiotapes. During her stay, she taught me to do household chores, such as cooking, cleaning, laundry, and sewing, so that I could take care of myself. To this day, I use those life skills; I will always be grateful.

Although my grandmother was there to help, I also knew that I was partially responsible for my younger siblings. Not even 9 years old, I felt as if I were (p. 125) a miniature adult. After seeing my mother standing atop a chair with a noose in her hand, I felt incredibly numb and confused. I blocked most of these images and emotions; letting them in would be too threatening, especially when I was left with little or no information on what was now happening with my mother.

Shutting out traumatic events was not overly difficult. I learned it well when I was very young, after my corrective surgery for my cleft palate. But the price was never fully processing the fact that my mother was gone. My parents’ disappearance left me feeling rejected. Evenings were the worst. As I lay in bed, questions echoed within me. Why did they not take us back to Hong Kong? How could they leave us here with grandma? I felt alone in darkness.

Sticks and Stones: Shaming Lies and Gossip

After spending about 6 months in Hong Kong, my father returned without my mother. I was happy that he returned, but life was not the same. For the next 2 years, my brother and I continued walking to school alone. Because my father worked late into the evenings, our grandmother became our surrogate mother. She attended teacher-parent meetings and open houses at school. I felt ashamed because I was different from most of my peers. Fortunately, I had an understanding teacher and a small group of good friends who helped me adjust at school.

Among my friends were three brothers who lived in a neighboring home. After school or on weekends, we often played football or rode our bikes. One day during our games, one of the boys asked us where our mother was. Before we could respond, the youngest of the brothers said, “Your mother was talking crazy, and the police took her away.” Embarrassed and hurt, I instantly suppressed the urge to punch him.

As a child, I did not know that my friend was not intentionally being insensitive. Reflecting on this experience, I wonder how he got the idea that my mother was “crazy,” taken away by the police. Were people gossiping and spreading lies and half-truths about her? Is the image of a person suffering from mental illness that of someone in a straightjacket, taken away by the police while kicking and screaming? As a 9-year-old, I felt the bruising slap as I came face-to-face with how society perceives and stigmatizes individuals suffering from mental illness.

Out of Sight but not out of Mind: Separation, Secrecy, and Suspicion

Two years had passed since our mother vanished from our lives. My father and grandmother veiled most of the details about our mother’s condition, fueling uncertainty and anxiety. Where was she? How was she doing? Is she coming back? (p. 126) During late evenings when my father was working, my grandmother sometimes spoke with relatives on the phone after my siblings and I had gone to bed. Despite her attempts to keep her voice low, her whispers often escaped into the bedrooms like balloons on strings, floating away from the weakening grasps of children. Sounds traveled especially well from one room to another through the heater vents. As I quietly tiptoed out of bed to kneel next to the vent, I heard the words “electricity” and “shock.” In the darkness of my bedroom, I felt chills as I envisioned my mother enduring electroconvulsive therapy (ECT).

With my mother gone for 3 years by this time, I felt disappointed that my father had not brought her home. As a child, I was not ready to understand how my father must have felt. In retrospect, I can only imagine the pain, longing, and hardships that he endured as he forged ahead with three young children without the support of his wife. But at the bleakest moment, my aunt called from Hong Kong to give us news. Like sunlight breaking through the usual haze and fog of an early morning in San Francisco, we heard that my mother was well enough to return home.

The Reunion: Would I Remember her Face?

On the day that I would see my mother again, I hoped her return would offer answers to the questions that had haunted me for the past few years. She was scheduled to arrive back in the United States in the morning, when I would still be at school. That day, my attention drifted from my lessons to scenes of reuniting with her. The ringing of the school bell knocked me back to reality. Walking home with my brother, each step intensified the anxiety within me. It had taken me nearly 3 years to forget that I was living without her; how long would it take to remember how to live with her? Would I recognize her face? Equally important, would she remember and know me? No matter how slowly I walked to buy myself time to prepare, I eventually arrived home. Climbing the stairs of the house, I noticed the doorknob turning and the door cracking ajar. Our thumping footsteps must have alerted her. The door swung open to reveal my mother standing in the doorway. I immediately noticed her hair. Three years ago, she had had long, straight hair. Her hair was short and curly now. “Don’t you remember your own mother?” she joked. I nodded silently. “I haven’t seen you for so long, and you two are so tall now,” she continued with a smile.

To ease the tension, our mother told us that she had brought us some gifts. Hearing this news, my brother jumped up and down. As the oldest child, I chose to curb my enthusiasm, but I felt excited nonetheless. Our mother went to an adjacent room and returned with new backpacks, pencil cases, and handheld electronic games for us. We were most thrilled with the games. We immediately popped the batteries into them and began playing. Meanwhile, our mother (p. 127) brought out some candies and snacks for us. Having snacks after school with my mother reminded me of how things had been.

When my mother had returned to Hong Kong, my sister was a babbling toddler. Now, my sister was 5 years old and finishing preschool. While my brother and I played with our video games, I heard my mother talking and playing with my sister. Her lively and cheerful demeanor reminded me of how nurturing and warm she had been before her depression. Amidst our reunion, I noticed my father watching us with a faint smile. Toiling for years at the restaurant, my father had finally struggled his way to being a manager, giving us more time as a family. For 3 years, I had longed for such moments when we could truly be together. I deeply treasured common, everyday events such as family dinners that many people take for granted.

Culture and the Meaning of Help-Seeking

Although my mother appeared much better, she was still not fully recovered from her depression. Despite her reluctance to expose her illness to those outside the family, my father convinced her to seek professional help. Cultural beliefs were a major reason that my mother (Chinese and an immigrant) resisted seeking professional help. Most important, my mother and father did not have (p. 128) a clear understanding of depression. Certainly, they did not acknowledge severe depression as a serious mental illness. Their misinformation was also indicated by their belief (perpetuated by many in the Chinese community) that eating healthy foods and taking herbal remedies could cure depression. As a child, I, too, sensed that depression was temporary and that a person could overcome depression with a strong will and conviction.

Fortunately, such home remedies and folk assumptions were balanced with help from professionals. My father sought help for my mother at a low-cost community health clinic with a Chinese-speaking psychotherapist. An entirely Western concept, therapy was foreign and even antithetical to my mother’s beliefs. Most traditional Chinese people are uncomfortable sharing private or familial information with people outside the family. Because individuals afflicted with mental illness are stigmatized, seeking professional help would reflect poorly, bringing shame to self and family.

I met her psychotherapist once after their sessions. In somewhat broken Chinese, she struggled in translating to my father that my mother was doing well. I instantly recognized that language was one of the barriers that kept my mother from truly connecting with her; she probably saw her therapist as an “outsider.” The guilt and shame of leaking deeply personal or private information to such an outsider made it easy for my mother to abruptly terminate treatment after only a few sessions.

Although my mother had cut short her treatment, her condition appeared to improve. At the very least, seeking treatment meant that she had confronted the fact that she suffered from mood disorder. In addition, the responsibilities of motherhood gently nudged her toward independence and confidence. After my sister entered kindergarten, my mother decided that it was time to reenter the work force. Despite our family’s limited budget, my mother worked hard to arrange for after-school activities and supervision. A babysitter cared for my sister, while my brother and I participated in educational, sports, or musical activities. Doing so freed our mother to pursue her goals.

Applying for jobs was a major step forward in my mother’s recovery process. At the same time, it exposed her to risks of disappointment, rejection, and stress. Was she ready to handle it? After several interviews, she found part-time work operating a photocopying shop independently. She enjoyed the autonomy, and her naturally gregarious personality helped her to easily make friends with the neighborhood customers.

After settling into her job, she decided to enroll in an English course, designed for immigrants, at the local community college. In addition to improving her English skills, the course gave her a chance to connect with other immigrants. In the evenings, my mother enjoyed talking with her classmates for hours on the telephone. At the end of the semester, she brought my siblings and me to a holiday party to meet her classmates. At that age, I thought of school as a place (p. 129) for children or teenagers. My mother changed my misconception by showing me that education is a lifelong process. Admittedly, I felt embarrassed as she introduced me to her classmates and teacher, but I was thrilled to see that she had a supportive group of friends. Afterward, she attended additional English classes and some computer courses. She had such enthusiasm and connectedness that I wondered whether her teachers and classmates could have guessed that she had recently battled severe depression.

With no obvious signs of relapse after many months, my mother appeared fully recovered from depression. She worked particularly hard at providing us with enriched educational and recreational experiences. Perhaps she was compensating for not being available during her illness; perhaps she was just showing us what her depression had previously veiled. All I knew was that she was an incredibly dedicated and caring mother. If we ever experienced problems at school, she advocated for us by meeting with our teachers to propose and find alternatives and solutions.

For several years, I was in a bilingual classroom. However, there was a lag in my transition, and I was falling behind in my course work. My mother grew concerned and hired a private tutor. Despite working tirelessly for low wages, my parents never hesitated to invest in their children’s education. Seeing how committed my parents were helped reduce my anxieties and insecurities that lingered from times that they had been gone.

The Ugly Faces of Insecurity and Inadequacy: Good Enough is not Good Enough

After my mother’s condition stabilized, some sense of normalcy returned for my family. I felt relieved at not having to try so hard to block out the vivid images of my mother’s attempted suicide. Perhaps, more accurately, their powers to intrude on my consciousness were waning. Nonetheless, those early experiences of witnessing my mother’s depressive episodes changed me forever. As the oldest child, I felt deeply obligated to make things perfect for my family at a time when everything appeared so imperfect. Living with a depressed parent, I learned empathy and sympathy for others who were suffering or were in need. When my parents were gone, I felt deeply responsible for my siblings. Over time, I began caring for everyone else except myself.

Entering early adolescence, I finally felt as if my family could pass as “normal.” But the rumors and gossip about my mother’s depression and institutionalization still echoed within me. “Saving face” is an extremely important concept and social custom in traditional Chinese culture, related to social perceptions of a person’s status or prestige in the community. To save face, people should (p. 130) not embarrass themselves or their families. Consistent with such values, I hid the fact that my mother suffered from depression.

By the time I reached high school, I became accustomed to working incredibly hard to excel in a variety of activities. If I earned good grades and won awards for art, music, or athletic activities, perhaps I could disguise how imperfect my family once was. I wanted to show others and myself that we were, if not perfect, at the very least “normal.”

During my late adolescence, my mother appeared fully recovered from depression, and I shifted my attention from the brokenness of her life to mine. My adolescent years felt chaotic. When it came time to consider college applications, I felt lost, because my parents knew little about the American educational system. When my high school career counselor advised that my grades were good but that additional extracurricular activities would enhance my applications, I felt as thought I were not quite good enough.

The loneliness and shame that I experienced from my mother’s mental illness continued shadowing me. Anticipating college applications, I engineered a schedule that I thought would prove I was in fact “good enough.” A typical school day felt incredibly packed as I rushed to choral practice 1 hour before classes even officially started. How else could I fit everything into a single day? During lunchtime, I took only 15 minutes to eat so that I could squeeze in music rehearsals or meetings of social clubs and organizations.

After school, I trained for and competed on the high school cross-country or the track and field teams. Studies and homework were frantically completed before dinner, followed by an hour of rest so I could digest the food before rushing off to private gymnastics training. During workouts, I cycled through about 1 1/2 to 2 hours of bending, stretching, contorting, and somersaulting to sculpt my already exhausted body. Workouts ended around 9 o’clock, when I waited for the bus to return home. Before crashing into bed, I completed studies or homework that I hadn’t finished earlier.

Waking up in the mornings, I would lay motionless in bed with sensations of soreness and pain saturating my battered body. The slightest shifts or movements triggered sharp aches. But I had become good at enduring pain. And, with only piano lessons on Saturdays and church activities on Sundays, I had the weekends reserved for recuperating and resting.

Crossing the Bridge: Transition to College and Adulthood

Both despite and because of my outrageously imbalanced lifestyle, I won several academic scholarships and awards during my final year of high school. I was relieved that I was accepted into my first-choice college, the University (p. 131) of California, Berkeley. My parents didn’t know much about American universities, but they knew two things about Berkeley. First, they knew that it was only across the Oakland Bay Bridge from San Francisco and were thrilled that I would be near them. Second, they knew that Berkeley is renowned as one of the best public universities nationally and internationally. To this date, I cannot recall feeling as ecstatic about any news I had ever received as I was the moment I discovered that I would be going to Berkeley.

Heading to one of my first courses at the university, I fought through a sea of students as I found my way to the lecture hall. Getting a little lost along the way, I entered the building about 5 or 10 minutes late and found an auditorium filled with nearly 500 students. With all seats filled, I found a spot on the floor and sat in the aisle of the auditorium, along with a swarm of other students. The room was so enormous that the professor spoke with a microphone. The professor asked us to look to our left and right, warning us that more seats would be available after a few weeks when many of us would drop out. The auditorium was silenced. Seconds later, silence swelled into rumblings as students began feeling tense and wary.

Amidst the furious pace of assignments and exams, I was unprepared for university life but had little time to learn to adjust. My mind was flooded with so much information that I barely knew why or what I was studying. I was uninterested in my premedical courses, but my parents had made it clear that they wanted me to become a doctor, and I did not want to disappoint them. Miraculously, I survived my first semester of college despite very average academic performances amidst an anything-but-average student body.

The Night a Bullet was Fired into my Face

Performing progressively worse with each semester, I wondered if I belonged at the university. During my fourth semester, my most dreaded course was organic chemistry. I was on the verge of failing the course, and everything appeared meaningless as I struggled to memorize rather than to understand. As the final exam approached, I was sleep deprived and overdosing on coffee, which left me feeling constantly jittery and anxious. On the last night before the final exam, I desperately crammed and memorized information that appeared disconnected and incoherent. I no longer cared whether I was learning; I only wanted to pass the course.

Exhausted, I realized that I had 4 hours before my final exam. I felt that it was useless cramming any longer, so I napped briefly to be refreshed before the exam. I woke screaming, with the image of a gun pointed at me, a bullet fired into my face. I rarely had nightmares, so this really disturbed me. Heading into the exam, I hoped to pass the course after spending so many hours memorizing facts. After the exam, I was relieved. It was over.

(p. 132) The end of the semester marked the beginning of winter vacation. I was glad to escape the university environment but ashamed to face my parents. After being silent and moody for days, I eventually disclosed to my parents that I had probably failed one course. My parents were understanding but encouraged me to continue pursuing premedical courses. “Just try your best and work harder,” my mother consoled me. “Keep trying and work harder,” my father advised.

There is something about the phenomenon of actually seeing something that forever leaves a mark on you. The day that I witnessed my failing grade printed on my transcript was the day that I felt officially branded as a failure. When spring semester started, I returned to the academic world feeling stupid and worthless. I felt that I didn’t belong, but I mustered enough effort to repeat and pass my organic chemistry course. Despite running on the last traces of faith within me, I refused to give up on myself.

Such a last-ditch effort left me emotionally bankrupt. It took a long time, but I finally realized that I could no longer continue traveling down a path only to end up at a place where I never wanted or was meant to be. In my bedroom in my apartment, I sat alone on the floor in darkness. All I wanted was to sit silently with the lights off, hoping I could somehow fade and disappear into the darkness. As a child, I was known as a relatively fast runner. As an adult, I knew I could never escape myself, no matter how fast or far I ran. I wept quietly but aloud, breaking the deafening silence within me. Crying was not something I did easily. For years, I was afraid I had become so numb that I had forgotten how to cry. Growing up without my parents for a period of time during my mother’s depressive episode, I was often stoic. Throughout my childhood and youth, I wished that I could become a mechanical robot, because humans have emotions and could feel pain.

I felt the stinging, yet healing sensations in my past wounds. I resisted wiping my eyes so I could feel the tears stream down my face to my lips. I wanted to taste the salty waters that would wash away the years of silence and pain. Loosening the grasp of my childhood patterns that had helped me survive thus far, I was afraid but finally ready to look at myself, scars exposed. I knew that I had to take control of my life, and part of that meant taking control of my education. I decided to pursue a career in psychology, a field of my own choosing. Although my parents saw psychology as impractical, the mission and philosophy behind psychology resonated with my life experiences and goals.

Blindsided by Perfectionism and Panic

Earlier in my life, I had learned to cope with the chaos and brokenness of my life by trying to make myself and my environment appear in control or “normal.” I blamed myself for messing up the first 2 years of college. Now that I was (p. 133) pursuing a major of my choosing, I felt that I had to redeem myself by proving to myself and to my parents that I made a good decision. I relied on my old habits, orchestrating an array of academic and extracurricular activities that bound me to a rigid schedule. I exercised religiously as an outlet for the anxious energies that were pent up. I also volunteered with several campus and community organizations. By such immersion, I thought I was grounding myself. I wanted predictability or control in my life, even if it was only an illusion.

As I pressed forward with my rigid routine of activities, I crashed into a roadblock. On a seemingly typical morning, as I fought my way across campus through a swarm of students, out of nowhere I was blindsided. It took me some time before I realized that I was struck by panic. Strangers’ eyes immediately felt like daggers targeting and darting at me. My heart pounded as beads of sweat formed and felt like boulders rolling down my forehead. Heat spread like wildfire through my face. I worried how flushed my face must have looked to bystanders. I felt as though I was being choked and suffocated but dared not gasp for air. To minimize any movements that might attract attention, I tensed my muscles so tightly that I was in excruciating pain.

Soon, similar panic attacks struck me in the middle of lectures in class, while reading at a coffee shop, or when I was in public places such as a store or restaurant. I was constantly vigilant as I anticipated the next panic attack. The anxiety and wariness of anticipating the next panic attack were worse than enduring the attack itself.

My fear of being labeled as “crazy” kept me silent and only exacerbated my anxiety. The more I bottled up my anxieties, the more they rebelled to be set free. On my way to class one day, I noticed a neon-colored flier on a bulletin board in the hallway of the psychology department advertising counseling services for students at the health clinic. I quickly ripped the flier off the board and stuffed in it my backpack before anyone saw me. When I got home after classes, I took the crumpled flier and tossed it into the trash bin, annoyed that I had wasted my time taking it. The next morning, I saw the neon-colored flier peeking out of the trash container. Opening it up, I saw big bold letters spelling the “Stressed?” at the top of the flier. My answer was an emphatic “yes.”

But why would I seek counseling services from the student health clinic? Coming from an immigrant Chinese family, I felt particularly conflicted about sharing or entrusting personal and familial information with strangers. Most important, I resisted seeking help because I did not want to reveal or admit what I perceived as my vulnerabilities and imperfections to myself, much less anyone else.

Somehow I had mislearned that only crazy, strange, or weak people sought counseling or mental health services. But no matter how hard I tried, I could not “will” myself out of my panic attacks. My emotions continued to disrupt even the simplest daily events. Seeing no end to suffering alone, I eventually made (p. 134) an initial appointment at the student health clinic. Walking to the clinic for my intake visit, I felt nervous because I had no idea of what to expect.

After this visit, I met with a psychotherapist, who helped me learn ways to alleviate my distress, panic, and anxieties over five brief sessions. For example, I learned muscle relaxation, breathing, and visualization techniques. I also learned to identify specific environmental triggers that generally preceded my anxieties. By doing so, I learned how to interrupt the sequential pathway that led to my attacks. I felt empowered, knowing that I could consciously disassociate my feelings from those triggers. I also learned cognitive-behavioral techniques that helped minimize the intensity and duration of my distress. With practice, the attacks subsided. After my emotions were in balance, I was in a position to explore the issues underlying my anxieties. Working through such issues, I was informed by, rather than enslaved to, my past experiences and the emotions associated with them.

Pursuing a Career in Psychology

I was now able to invest my attention and energies toward academic and research activities. With my academic record already blemished, I struggled to complete my bachelor’s degree with respectable grades to have any chance at continuing on with graduate studies. At the same time, I knew that my parents were unenthusiastic about the social sciences. If I listened carefully, I could still hear their voices echoing that fields such as medicine, law, or business were legitimate, practical, and successful careers to pursue. I felt like a “bad son” when I chose to pursue a career in psychology. The lonely and abandoned part of me hungered for my parents’ approval, but the hurt and angry part of me wanted to rebel and prove that I could succeed in a field not of their choosing.

With ideas of becoming a clinical psychologist, I became friends with a cohort of classmates who also planned to pursue graduate studies in psychology. I finally felt a sense of community that I had yearned for throughout college. Clinical psychology has often been perceived as the most desirable area in psychology, and it is clearly the most competitive in terms of admission to graduate programs. I saw this as a chance for me to redeem myself from my dismal undergraduate career. Furthermore, my positive experiences with counseling and therapy convinced me that this was a field worth pursuing. As a senior, I applied to a list of extremely competitive programs, all of which were in California. My parents had not hidden the fact that they wanted me to remain as close to them as possible. In truth, I was not completely prepared to separate from my family and friends. Aware that my tarnished academic record and unimpressive entrance exam scores seriously handicapped my chances, I was disappointed but not surprised when I was rejected by all the programs.

(p. 135) Feeling unwanted, I resorted to handling my feelings of rejection as I did when I was an 8-year-old child without my mother and father: I blocked out my feelings so that I could press ahead. I was determined to reapply to clinical programs the following year. After consulting with others who advised me to focus on aspects of my application that I could improve, I spent my time studying for the graduate entrance exams and upgrading my research and applied skills. I blamed myself for inadequate preparation and soon developed frequent stomach pains or migraines. By the time that applications were due for my second attempt, I once again applied to competitive programs that were mostly in California. Although I was a stronger applicant than a year before, I still did not get in.

Like a scratched record or a skipping CD, phrases such as “it’s over” and “you really messed it up” repeated in my mind as I faced another round of rejection. I wanted to barricade myself from the world in my bed with blankets, burying my head in my pillows to muffle the critical words echoing in my head. I hated myself. I was acting as my mother did when she was depressed. To counteract this, I committed myself to a string of work, research, and volunteer activities. But even the simplest of tasks appeared unusually challenging, as every day ended with me on the verge of emotional breakdown. At the time, I had no idea that I was pushing myself deeper into depression by being overly demanding of myself.

Similar to my mother, I avoided seeking counseling or mental health services. Was I too proud, embarrassed, or ashamed—or simply not ready to share my feelings and thoughts with others? I avoided professional help for all of these reasons. Instead, I found emotional release through music. As an avid music collector, I spent many hours sifting through my collection of songs for the lyrics that spoke the words that I did not know how to express—or words that I was too afraid to speak myself.

Eventually, I grew dissatisfied with merely listening. Having been tormented as a child about my speech impediment, I hated hearing my voice, as it was associated with shame and pain. But I reached a stage at which I was finally ready to go beyond listening. With one note, I shattered a lifetime of silence. Singing at the piano, I discovered my voice. I realized that I could not understand myself, let alone be understood by anyone else, if I muted myself. So began a process of playing music, songwriting, writing poetry, and creating artistic sketches. It was not easy to listen and look at myself honestly, especially when it came to parts of me that I felt were dark or ugly.

I seriously evaluated what drove me to clinical psychology. What was I trying to prove by gaining admission into the most competitive area of psychology? Ever since performing poorly in the first few years of college and ultimately failing a course, I had been constantly trying to show everyone, including myself, that I was not stupid or too lazy to perform. It was exhausting to spend so (p. 136) much time and energy trying to convince everyone else about my self-worth. But perhaps I was the one who needed convincing.

Having experienced 2 consecutive years of rejection, I thought carefully before applying for a third time. This time, I approached the application process in an entirely different way. In selecting programs to target for my applications, I focused on research match. Because I was interested in studying emotions and self-regulation, I identified potential mentors who were conducting research on those topics. Awaiting the results of the application process, I felt relatively calm because I did the best that I could. Upon learning that I was accepted to developmental psychology programs in California and Arizona, I decided that Arizona State University’s program was the best fit. I was at ease even if I was traveling farther away from home.

Empty Nest: Transition for Everyone

Although pleased with my decision, I felt torn about leaving behind family and friends. San Francisco had been my home ever since leaving Hong Kong as a child. Questions roared within me: “With all the sacrifices that your parents made for you, how can you abandon them now? How can you be so selfish?” Guilt-ridden, I saw my move to Arizona as a decision to put my own needs above those of my family.

Both of my siblings were encountering major developmental milestones of their own. My brother had just graduated from college and started a desirable but demanding job in San Francisco. My “baby” sister had just left home to start college at Davis, 75 miles east of San Francisco. At a time when my sister and I were leaving home to pursue higher education, my parents, now in their 50s, were experiencing rocky times at work.

Since arriving in the United States, my father had given his entire working life to the restaurant business. He did not expect to be laid off abruptly when the restaurant’s business declined and eventually went bankrupt. I felt secure growing up, not because he worked in a prestigious or lucrative profession—in fact, he toiled for meager wages in a restaurant in Chinatown—but because he showed his care, dedication, and determination by providing for us without complaint, even when my mother was institutionalized in Hong Kong. Even though I was now an adult who could earn a living and help support my family, my father’s unemployment still signaled impending instability for the family. Finding employment was challenging for him, especially as he did not have educational credentials from the United States. After scrambling for months, he finally found work in the hotel industry doing housekeeping.

At the same time, my mother felt intensely pressured to maintain some kind of income at the bank where she worked. This coincided with major changes (p. 137) in the entire banking industry that included “phasing out” of the traditional bank teller through the introduction of self-service and computerized banking. Consistent with such trends, my mother’s workplace began major reorganization and downsizing. Her bank began testing the employees on the new banking procedures on a weekly basis. I saw her memorizing thick training manuals late into the evenings. Nearly three decades older than many of her coworkers, she also began experiencing hot flashes, heart palpitations, dizziness, and lapses in memory indicative of menopause.

On the night before I drove to Arizona, I slept uncomfortably and woke early the next morning to the sounds of my mother preparing breakfast. As I ate, she advised, “Don’t eat too much fast and fried foods. Eat more fresh vegetables and fruits.” My father hurriedly interjected with his reminders, “Remember to change the oil in your car regularly, and check your air filter and antifreeze.”Although our farewells apparently revolved around trivial matters, I understood that they were expressing their caring and concern for me. Pulling out of the driveway, I saw the images of my family diminish, fade, and eventually vanish in the rearview mirror as I trekked from the Pacific Ocean of California to the Sonoran desert of Arizona. I was awed by the statuesque Saguaro cacti, some nearing 30 feet tall, lining the freeway. Approaching Phoenix, I was captivated by the beautiful hues of red, green, and copper in the mountains that fortressed the city.

Shortly after settling into my apartment in Tempe, a suburb of Phoenix, I received a call on my mobile telephone from my brother, alerting me that our mother had collapsed at work. I asked to speak with her on the telephone, and she faintly whispered that she was “dizzy and overheated.” The next morning, my father telephoned her workplace to request a sick leave for her. Concerned, he prepared soups and forcibly fed her to sustain her, even though she had little appetite and refused to eat. Over the next few days, she disappeared behind the bedsheets and blankets, reappearing only to use the restroom.

Relapse into Darkness—and Mania

Continuing to shield herself underneath her blankets, my mother isolated herself in the darkness of her bedroom. My father and brother could do little to convince her to leave her room; soon, they could not ignore the stench that permeated the air from the bedsheets and blanket. Although the bank manager insisted that she return to work only when she was in good health and ready, my mother began panicking that she might lose her job if she stayed home too long. She decided that she would have to upgrade her computer skills if she was ever to return to work at the bank.

As if bursting out of the dark bedroom in which she had imprisoned herself, she stayed awake for 2 or 3 days to memorize her computer manuals. Exuding (p. 138) a frighteningly intense and frenzied force, she made her way to the local community college and enrolled in computer and English courses. She also found energy for aerobics classes at a local gymnasium. We were initially relieved to see her outside of the home. But soon, I sensed that her frenetic energy would ignite and launch her into a relapse of severe depression. In fact, this turned out to be the case: she was experiencing hypomania, and a repeated series of manic episodes and depressions followed.

The longer my family and I denied that my mother was afflicted with mental illness requiring medical or psychological treatment, the longer we delayed reexperiencing the pain that we felt from her first major episode. In a strange way, we earnestly believed that we could properly care for and heal her. Although we wanted to hide her illness from others, we could not keep her hidden.

Relatives and friends who knew about my mother frequently advised my father on how to painstakingly prepare ancient Chinese remedies of soups or herbal teas that could allegedly cure her illness. My brother and sister did their parts: tediously sifting through scientific and medical articles on depression in the libraries or on the Internet, my brother researched the latest information on diagnosis and treatment, and my sister gave up time bonding with her peers during her first year in college to stay with our mother every weekend. As the only child living far away from my parents, I felt powerless to help.

From Arizona, I felt as if I were a despicable and ungrateful son who had chosen to live away from his family. Given that familial connectedness is heavily emphasized in traditional Chinese culture, how could I be so disloyal and selfish? How could I choose to pursue a doctorate in psychology at a time like this? I began feeling that graduate studies were utterly unnecessary and self-indulgent.

One evening, my aunt (my mother’s younger sister) telephoned me from Australia. She asked how I was doing in school and how I liked living in Arizona. I kept my update brief and shifted our conversation to my mother. A registered nurse, my aunt had cared for my mother in Hong Kong during the first major depressive episode, so she was familiar with some of my mother’s symptoms. My aunt questioned me, “You’re studying psychology, so why don’t you help her? Is it possible to take a leave of absence from school?” I told her that I would think about it. Her words haunted me long after our conversation. I began seriously questioning whether I was secretly using graduate school as an excuse to escape the responsibilities and burden of caring for my mother.

My father and siblings were supportive of my decision to continue with graduate studies, but my mother sent conflicting messages. During her depressed state, she often told me over the telephone to “quit school and come home. People your age should be working and making money already.” On the other hand, during her manic phases, she told me in a matter-of-fact tone to (p. 139) “never come home because there is no room here for you.” With such opposing messages, I didn’t know what to expect from her anymore.

As a child, I had witnessed firsthand some of my mother’s early symptoms during her first depressive episode. As an adult, I was now experiencing her problems primarily from afar. Only after contrasting and then integrating my experiences as an insider and outsider was I able to appreciate how my mother’s depression incapacitated not only her, but our entire family, physically and emotionally. When my brother informed me that she had locked herself in the bedroom, I knew that her silence and stillness forecasted an impending shakeup. We were familiar with waiting through the days or weeks of lethargy, which eventually swelled into a seismic force.

When my mother finally unleashed the manic energy that had lain dormant, her behaviors were excessive but initially benign. She frequently telephoned every person listed in her telephone directory. Even late into the evenings, she disturbed many of her long-time friends to complain or engage in self-blame. Sooner or later, her friends came to ignore or reject her telephone calls. With few outlets for her rabid energy, she began leaving the house to shop. Eventually, her excessive shopping morphed into persistent and aimless roaming and wandering in the streets. The contrast was striking: whereas she could hardly be forced out of the home during her depressed states, my father could barely prevent her from leaving the house during her manic phases.

Because she needed constant supervision, my father and brother soon became captives of her mental illness. Working the graveyard shift, my father remained home with my mother during the day. After work, he rarely got the sleep that he needed. Although in-home professional care was an option, it was extremely expensive and would expose her condition to more people outside of the family. When the situation became unbearable for my father, my brother rearranged his schedule to work from home as often as possible. It became clear that they could not properly supervise my mother without additional help.

During her manic episodes, my mother often forced her way or snuck out of the home. One evening, our neighbors complained to my father, “Your wife was bothering us. She said that she was homeless and wanted us to take her into our home. What is going on?” My father questioned my mother about what happened and was left stunned to discover that she had routinely been asking strangers for shelter. On the telephone with me, she lamented, “Your father is better off without me. He should remarry and just put me out on the streets so I could be homeless. Your lives would be better without me.” She also told me that she occasionally asked strangers to give her rides if she roamed too far from home. Hearing such news sent chills through me, as stereotypes of a homeless mentally ill person, roaming and babbling in the streets, flashed across my mind.

(p. 140) Our fears that her manic behaviors would get her into serious trouble were confirmed late one evening when my brother telephoned me to inform me that “the police took mom away.” Momentarily, I felt as if I were 9 years old, with the voice of my childhood friend, taunting me about the police taking my mother away, echoing in my mind. The neighbors were upset that my mother rang their doorbells and claimed that she was homeless and needed shelter. “The police took her in for trespassing,” my brother explained in a calm yet uncertain voice.

With police intervention, my father escorted and admitted my mother into a publicly funded psychiatric hospital. After three evenings, she was released, with medication to suppress her anxiety and psychotic symptoms. On returning home, she cocooned in bed nearly every day. Sedated by the medication, she remained relatively disoriented. She frequently complained of dry mouth, loss of appetite, and constipation from her medication. By that point, we were happier with the choice of her being sedated at home rather than roaming the streets.

Roadblocks to Recovery: Denial, Resistance, and Noncompliance

Although medication alleviated some of my mother’s depressive and manic symptoms, it could not help her accept that she was suffering from mental illness. Insisting that she was not depressed, she challenged any notion of needing professional help or medication. Initially, she flushed her pills down the toilet. When my father and brother began closer monitoring, she developed increasingly clever methods to outmaneuver them, for example, hiding the pills under her tongue or in her cheek. When confronted, she adamantly roared back that she was “not really sick, but only acting sick.” She insisted, “I acted sick because I don’t want to work. I am lazy. I just want to stay at home.”

My mother’s explanations angered my father. Awed by her stubbornness and damned by her illness, my father combusted, “Just get better! Why are you torturing yourself and your family?” Perhaps he was unable or unwilling to truly understand her illness. Perhaps, like my mother, he was resisting the realization that she truly suffered from a serious mental illness. Maybe he did not realize that her psychotic and depressive or manic symptoms were often beyond her voluntary or volitional control. His outrage eventually subsided to desperate pleas: “I beg you. Please, stop doing this to yourself and your family.” On hearing such updates by telephone, I felt deep sorrow for my father. In his early 60s and working the graveyard shift to sustain some kind of medical insurance for himself and my mother, he did not deserve such punishing circumstances.

(p. 141) Reunion Revisited

Thanksgiving gave me the first opportunity to have somewhat of an extended visit with my family. The days prior to my visit were smeared with chaotic swirls of longing to see my family blended with anxiety, guilt, and apprehension. My father confided what he expected from me: “With all your years of schooling, you must speak with your mother. What good is all your education if you can’t use it?” Despite the fact that I was specializing in developmental rather than clinical psychology, my family desperately hoped that I could do something to help. They did not comprehend that I was not a trained therapist or counselor. In truth, I also wished I knew how to help my mother.

On my flight to San Francisco, I felt pushed and pulled in multiple, conflicting directions as I rehearsed scenes of the upcoming reunion. Oddly, I felt trapped in a film, one that was looping in an old film projector. I was still embodying the life of a lonely and frightened child who marched up the stairs in anticipation of reuniting with his mother who had disappeared for nearly 3 years. As the wheels of the airplane touched ground, I was snapped back into the moment by the jolt of the landing. I felt harried as I darted through the crowded airport to the meeting area where my father waited. On seeing him, my eyes strayed from his warm smile to the lines and wrinkles that carved his gaunt face. In just 6 months, he had markedly aged and weathered.

On our way home, he warned me, “Your mother is not doing well. She is always in the bedroom. You have to talk to her.” As I stepped inside our home, I noticed down the hallway that the door to my parents’ bedroom was slightly ajar. Although I wanted a little time to gather myself before seeing my mother, I forced myself down the hallway and knocked gently at the door. Not sure if she was awake or asleep, I waited, in silence. I was somehow relieved, thinking that she might be asleep. But weak murmurs broke through the dead air trapped within her room. Peeking inside, I saw that she was under the covers with her back to me. To get her attention without startling her, I tiptoed toward her and quietly whispered, “Mom, I’m home.”

Spiritless, my mother summoned enough strength to toss the covers off as if struggling to free her from a cocoon. As she slowly turned her body and head toward me, she appeared both familiar and unfamiliar. Her grayed and tangled hair framed her flushed and bloated face. Squinting, she appeared as if fighting to keep her eyes from shutting. She mumbled in a hushed but assertive voice, “Why are you here? You should not have come to see me. You can’t stay here. Go back to Arizona. I am dying here.” Unsure how to react, I told her that I was visiting for a few days and asked about her rest and appetite. “I just lie in bed all day, but my mind and my heart stay awake. My mouth is dry. I am not sick, but the medicine makes me sick.” I listened, but I had no solutions. I prompted, “We should do something while I am home. Where do you want to go?” She (p. 142) responded in an insulted manner, “How can I go anywhere? I don’t know how to walk anymore. My legs don’t work.” Puzzled, I told her that we could do something after I unpacked my luggage.

Shortly after I went to unpack my suitcase, my mother stumbled out to the kitchen and hurriedly shoved foods such as grapes and breads into her mouth. As she ate, I noticed spurts of physical tremors in her hands and occasionally through her face and mouth. In addition, I noticed that her feet tapped when she stood still. Ironically, she was moving but going nowhere. Her “pitter-patter” footsteps reminded me of the aftershocks that I felt as a 16-year-old during the 1989 Loma Prieta earthquake. Might she be showing signs of neuromuscular or psychosomatic problems? Because she was under the supervision of a psychiatrist, I tried to reassure myself that her physical and mental health was being monitored and that her behavioral symptoms might reflect the side effects from her medication.

Mother, Where are you?

My return home made me realize how the distance during graduate studies had blinded me to, and protected me from, how severely her mental illness had affected her entire being. Yet such distance gave me an “outsider” perspective, allowing me to see my mother’s condition through different lenses. I did not see a woman who was acting or pretending in ways to cause chaos for her family. Rather, I saw a woman who was acting in ways not under her volitional control—a person with a mental illness. Similar to people with many types of illnesses, such as diabetes, she could function and live a happy, productive, and healthy life with proper diagnosis and treatment. However, the critical hurdle was breaking down the resistance that kept her from accepting that she was mentally ill so that she would seek and benefit from treatment.

As the Thanksgiving weekend came to an end, I knew that my time with my mother was precious. Too often, I rushed through life, with people, things, and events blurring and fading into the background. I slowed things down by momentarily staring at her face. I could finally see my mother as the person who had made the suicide attempt I witnessed as a child and one also in the midst of severe depression. Her face was flushed red and bloated, and her eyes were glassy. She was not the woman I once knew. I wondered to myself, “What can I do to reach you? How do I connect with you? Mother, where are you?” I was staring at a woman who was strong and independent, but also broken and vulnerable.

With the chronic stress of caring for my depressed mother, my father and brother were developing health problems. My father suffered from chronic coughing, and my brother experienced recurring bouts of stomach and chest (p. 143) pains. Although my mother routinely berated my father and brother, she was more harsh with and critical of herself. She lamented, “I am not a good mother. I did not raise you properly. And I don’t know English. You kids don’t know English either. We all have very bad education.” I was baffled, wondering if she felt that she had sacrificed her own educational or career opportunities so that her children could achieve at least a college education. With these questions burning within me as I departed, I struggled to keep pace with my graduate studies.

Listen without Judgment: Making Sense of Nonsense

I made subsequent visits every 2 to 3 months over the next 2 years, spending much of my time listening to my mother ramble endlessly. She routinely declared, “Our family is cursed. We are dying!” But the more I listened, the more I learned to see my mother. Dispersed within her nonsensical ramblings, she revealed, “I lost my mother when I was only a teenager. She died from breast cancer. The doctors discovered the cancer very late, and they could do nothing. Even my uncle who was a doctor tried everything to save her, but it was too late. Because I lost my mother when I was so young, I don’t know how to be a good mother to you.” Hearing about her loss at an early age, I imagined the loneliness and fear she must have experienced as a youth and into adulthood. Even though I sympathized with her, I realized that I don’t truly understand the depth of her loss. Although my mother had returned to us after seeking treatment in Hong Kong, her own mother had never come back.

My mother rarely talked about her mother and her youth, and I finally understood why. As the oldest daughter of seven children, she naturally assumed the role of caregiver with the passing of her mother, shouldering the housekeeping responsibilities for her family and parenting her younger siblings. Pressured into forsaking her educational aspirations to help with her father’s business, she pursued a degree in accounting. She recalled having to do accounting and bookkeeping for her father’s business that left her little time to pursue her goals.

Over the following 2 years, my mother vacillated between periods of depression and mania. While the psychiatrists experimented with the types and dosages of medication for her symptoms, she continued avoiding taking the prescriptions. With such noncompliance, she cycled through extreme depressive and manic states that lasted from a few days to a few weeks each. As if needing some rest before lurching from one extreme to another, she would enter the “calm before the storm.” During such periods, she appeared relatively serene and logical.

Because my father continued holding out hope that my mother would recover from her depression by “snapping out of it,” these calm periods reinforced (p. 144) and prolonged his denial. Inevitably, he would be gravely disappointed when his wife slipped back into depression. I grew increasingly concerned for my father’s health. Despite frequent visits to the doctor, my father’s cough persisted. After months of taking cough syrup that the doctor prescribed, the cough worsened. When he began coughing blood, the doctor prescribed him an asthma inhaler.

In the Clutches of Abandonment

Three years into my graduate studies, I struggled to find motivation and focus in order to complete my master’s thesis. Writing late one evening, I was surprised by a telephone call from my brother. It was nearly 2 a. m., and I immediately wondered whether our mother had been arrested after having wandered off. In a calm voice, he explained, “I’m at the emergency room now with Dad. He couldn’t breathe in the middle of the night. He was rushed here and they performed an emergency tracheotomy. Can you call home to check on Mom? She’s alone.” I asked him to call me when he had more information. I then called my mother, who sounded disoriented. I comforted her as I silently worried how my siblings and I would manage with both parents afflicted with serious illnesses.

Early the next morning, my brother called to inform me about my father’s condition. Had my father not been rushed to the emergency room, the doctor indicated that he would have suffocated and died in his sleep. To save him from suffocation, the doctors had to immediately puncture a hole in his neck to create a breathing passage. Somehow, it took me several minutes to realize that such a procedure meant the destruction of my father’s larynx, or voice box. It hit me that I would never hear my father’s natural voice again. I barely had time to process my thoughts and emotions before my brother braced me for additional news. After the tracheotomy, the doctors discovered a lump. Was the tumor malignant? Statistically, my father was at relatively low risk for cancer. He did not have a family history, he did not smoke, and he was an identical twin whose brother did not manifest similar problems. No matter how much I rationalized, I knew the tumor could possibly be cancerous. Awaiting the test results, we all felt powerless.

Several days later, my brother called to say that the test results indicated that my father was already in a very late stage (stage 4) of laryngeal cancer. I momentarily felt numb, but then I felt a swelling seed of anger burgeon within me. For over a year, my father had visited the doctors complaining of coughing and throat problems. How could they have ignored him, and then prescribed him an asthma inhaler? Would an inhaler prevent him from nearly suffocating to death in his sleep from a cancerous tumor blocking his airway? How did such a flagrant misdiagnosis happen? I silenced the inner screaming so I could focus on the immediate situation of keeping my father alive. With no time to waste, (p. 145) my father was scheduled for immediate removal of the tumor and all the tissues surrounding his larynx. At such final stages of cancer, the doctors recommended “gutting” the inside of his neck to remove lymph nodes to which the cancer might have spread. After informing my academic advisors about my father’s condition, I immediately booked a flight back to San Francisco.

On my flight over the Sonoran Desert toward the Pacific Ocean, I constantly glanced at my watch and wondered how my father’s operation was going. After I landed, my brother rushed me home so we could pick up our mother and sister before heading to the hospital. At home, I found my mother still wearing her pajamas, pacing frantically from room to room. I hurriedly asked her to change her clothes so we could go see my father. She wailed, “I am not going. What if your daddy dies? What will I do then?”

Although I knew that she was mentally ill and not herself, I became frustrated and angry. How could she be so focused on herself at a time like this? Likewise, my brother became upset and demanded, “You’re coming with us. Dad needs to see us.” After much arguing, we arrived at the hospital. Before entering the patient room, I hesitated. Was his neck mutilated? Would he be awake? I entered cautiously and saw him asleep. His neck was heavily bandaged, soaked and stained in crimson. As my siblings and I approached him, his eyelids convulsed like little earthquakes as he fought to barely crack open his eyes. As soon as he recognized us, he struggled to raise the corners of his mouth to signal a barely noticeable smile. My mother stayed away from my father, and I heard her “pitter-patter” footsteps from a distant corner of the room. Eventually, she shuffled toward us, looked at my father, and mourned, “He is mute. How could our family go on? He is crippled!” My siblings and I were horrified, and my heart ached as I saw tears streaming from my father’s eyes down his face.

When my father returned home, we tried our best to accommodate his needs. We gave him a bell to signal for help in case of emergencies. We also made sure he had pens and paper readily available to communicate with us. One of his first written requests was for us to initiate legal paperwork for wills and trusts for the family. Seeing such a request on paper made me realize that losing my father was a very real possibility. His prognosis was not good. The doctors recommended aggressive radiation therapy soon after his wounds healed. Despite the potentially debilitating effects, my father agreed without hesitation to any treatment that might give him a chance at survival.

Whereas my father was a model patient who complied with doctors’ orders, my mother continued to resist treatment and medication for her mood disorder. I increasingly resented the way that she intensified stress for my father as he fought to stay alive. In retrospect, I recognize that the possibility of losing her husband to cancer must have left my mother feeling extremely threatened, as it had with her own mother so many years ago. Given her severe depression, (p. 146) perhaps lashing out against my father was her way of showing how much pain she felt.

Perception Becomes Reality: The Mentally Ill as Nuisance and Outcast

My mother’s yo-yoing from the extreme lows of depression to the extreme highs of mania for more than 4 years was wearing out the tattered string that held our family together. With the added stressor of my father’s battle with cancer, that string was at risk of snapping. With my sister and me in school, my brother was the only family member working full time. Living with my parents, he had become their primary caregiver and an easy target for my parents’ displaced frustrations. Juggling professional and familial obligations, he soon became visibly worn and unnaturally gaunt. With chronic stress, he developed a persistent cough in addition to the stomach and chest pains he had been previously experiencing. Despite multiple visits to the doctor, his cough persisted.

Sounds of my brother’s cough triggered anger from my father. If the coughing continued, my father often picked up his voice machine and berated my brother as if he were doing it intentionally. My brother recounted that my father would frequently stomp out of the room while slamming the door behind him. I imagine that every time that my father heard my brother coughing was probably a painful reminder of his too-late diagnosis and subsequent loss of his larynx to cancer.

My mother reacted to my brother’s declining health very differently, becoming more convinced than ever that she was responsible for the physical illnesses of my father and brother. Seeing herself as a nuisance to her family, she pleaded for a divorce.

Sadly, we had also begun seeing my mother as an annoyance. There were times when I felt so upset that I partially blamed her for the hardships that our family had to endure. I had lost sight of the fact that she deserved sympathy and understanding as a person who was suffering from mental illness. After years of watching her failure to comply with medication, my brother and I contemplated whether electroconvulsive therapy (ECT) was the only viable and effective treatment.

Initially, we had kept our mother’s depression relatively hidden. But after my father was diagnosed with cancer, we reached out to relatives and friends for help and support. In particular, the minister and church members offered significant help. My family had been Christians for at least three generations, and my mother was a relatively religious woman. But it was not until after my father’s bout with cancer that her manic episodes took on religious themes. She became obsessed with studying the Bible, convinced that her depression was a (p. 147) sign of weakness in her faith and a punishment from God. To ward off Satan, she rabidly recited Biblical scriptures throughout day and night. Her religious fervor often lasted for several days before transitioning to periods of obsessive housecleaning or excessive shopping. She then progressed to socially inappropriate or risky behaviors, such as roaming and disturbing bystanders and neighbors.

No Place like Home: Back on Track to Recovery

After vacillating about whether to keep our mother home or admit her into the psychiatric hospital, we finally conceded to professional consultation and intervention in a hospital. The psychiatrist recommended a variety of treatment options, including ECT. Given my mother’s experiences with ECT in Hong Kong, I felt extremely uncomfortable with this treatment. But I also learned that it was a relatively safe procedure involving mild risks of memory loss. Still, my mother refused to consent to the procedure. We agreed on medication even though she had a history of noncompliance with such treatment. After a week in the psychiatry ward to stabilize her condition, my mother was released and returned home.

My brother and I felt desperate to try something that could possibly help her. We collaborated on a plan to create an environment that would support her taking medication on a daily basis. I relied on my experiences working with aggressive and defiant children in devising a behavior modification program. My brother would be responsible for implementing the program, consisting of concrete activities, rules, reinforcers, and consequences. We also focused on engaging our mother in physical and social activities within and outside the home. The basic rules were simple: we expected her to comply with her medication and to leave her bed and/or the home at least once a day. Yet enforcing these rules was not easy at all.

Initially, our mother did not take my brother seriously. When she did not comply, my brother enforced mild but effective consequences. For example, he poured small amounts of cold water on her when she refused to get out of bed for most of the day. After testing the limits several times, she quickly learned that there were consequences.

With continuous medication and at least some social engagement outside the home, over a 6- to 8-month period my mother’s manic and depressive episodes became relatively brief and less intense. One day, she said that she was making an appointment for a haircut and permanent. The day after her hair appointment, she took the bus to go shopping for new clothes and skin care products. I was ecstatic about these simple, everyday events that had been missing from her life for so many years. She continued visits with psychiatrists every (p. 148) few months, finally receiving a diagnosis of bipolar disorder rather than major depressive disorder. Given that she had bounced between depressive and manic episodes for over 5 years, I was surprised that this diagnosis had not been made earlier. But an accurate diagnosis was difficult when the psychiatrists did not know whether her symptoms stemmed from a wrong prescription or from noncompliance with medication.

My mother began to direct her time and energies toward meaningful and productive goals. For example, she volunteered at nursing homes. At church, she volunteered as a caretaker for infants and toddlers whose parents were attending services. In addition, she actively participated in Bible study, prayer groups, and the choir. After gaining greater self-confidence with volunteer work, she felt restless and found part-time work as a housekeeper and babysitter. I was proud that she was finally integrating the activities that she enjoyed into her transition to a new stage of life.

Why had she resisted treatment for so many years? Why did we, her family members, enable her denial and noncompliance for so long—effectively serving as accomplices? Deceptive yet protective, denial is powerful and sometimes functional. Denial was what helped my mother as a teenager survive the loss and pain associated with the death of her mother. Denial was what helped her as an adult to survive the sudden changes in her world when she immigrated to the United States. But denial of her serious mood disorder proved to be devastating.

Although medication suppressed her manic and depressive symptoms, it offered no insight into what gave rise to her depression. I felt that she could benefit from psychotherapeutic treatment. Was she ready to reexperience all the losses in her life? How does one truly become ready to embrace the loss of a parent to cancer? I felt that I would be a hypocrite for pushing my mother to seek therapy when I had been so resistant to doing so myself. I can only imagine that after a lifetime of suppressing her own pain, she preferred to keep her feelings in hibernation.

Breaking through Stigma

After a year of recovery, my mother has resurfaced by living a satisfying, meaningful, and productive life. Until recently, I was incapable of fully grasping or accepting that my mother would likely need professional assistance throughout her life. Perhaps the 15 years between her first and second major depressive episodes had fooled me into believing that her depression had been “cured.” Although the time was ripe for her to benefit from psychotherapy or counseling, I struggled with whether it was my role to nudge her toward psychotherapeutic treatment.

Given that it had taken nearly a decade for her to accept medication, I realized that she would need time to become receptive to psychotherapy. Not (p. 149) surprisingly, she declined when I asked her to consider seeing a therapist or counselor. Her primary reason was that she needed a Chinese-speaking therapist. After searching for a while, my mother decided that she had no need for therapy because she had nothing to say to the therapist. Whereas medication is a relatively private form of treatment, psychotherapy requires sharing or exposing personal information with another person.

Given the stigma about mental illness, such exposure could be extremely threatening and shameful. False messages that psychiatry is a pseudo-science and that individuals who need antidepressants are weak continue to infest public consciousness. Internalized stigma is not just a theoretical construct to be discussed within academic circles; it lives within and among us, infecting each of us often without our knowing. Even when my mother’s depressive symptoms were relatively under control, she lived in fear. These fears were not completely unfounded: what if parents of the toddlers and children she babysat for learned about her past struggles with mental illness? Would they avoid her? Would they treat her differently? My mother’s concerns alerted me to the harm caused by misinformation and stigma.

Early in life, I learned lessons about stigma from my childhood friend who taunted me that the police had taken my mother away because she was “talking crazy.” As a child, I could not understand why my friend made such accusations against my mother. I now know that these comments reflected the way popular media and culture have traditionally portrayed the mentally ill: as social outcasts who should be taken and locked away. Unfortunately, misperceptions often warp our reality, and we act according to such generalizations and stereotypes that disrespect, discriminate against, and mistreat individuals with mental illness.

As a child, all I could do was swallow the gossip and lies I heard. In the process, I unknowingly accepted and legitimized the negative messages and stereotypes about my mother and everyone who suffers from mental illness. In writing about my mother’s experiences with bipolar disorder, I initially hesitated discussing my own struggles with anxiety and mild depression. But only through writing this chapter did I discover that I must stop swallowing the lies. I have learned that, as with any person afflicted with physical illness or unfortunate circumstances beyond their volitional control, individuals with mental illness deserve respect, sympathy, support, treatment, and healing.

Rather than being ashamed, I am proud of my mother for what she has achieved while living with mental illness. The fact that she has granted me permission to write about her experiences battling depression represents a significant step forward in breaking through her internalized stigma about mental illness. Only after escaping a great wind from the wilderness that threatened to tear my family apart did I understand the frailty and the strength within my mother—in fact, within everyone who lives with and tries to overcome mental illness by moving toward mental health.

(p. 150) As for my father, I am equally proud of him for his dedication to our family. More than 6 years in remission, he leads a productive life with stable health. In the process, he has demonstrated supernatural strength and courage in coping with and surviving cancer in the midst of my mother’s depressive episodes. He will never have the use of his natural voice, but he has discovered other means of expression.

Surrendering to and Conquering my own Worst Enemy

Now in their mid-60s, my parents have found ways to remain active and productive with part-time work or volunteer activities. As I near the end of this chapter about my mother’s battles with mental illness, I ironically arrive at the end of a significant chapter in my life. During the 7 years that I lived in Arizona, I was undergoing personal and professional growth amidst my parents’ illnesses and my graduate studies. As I neared the end of my graduate career at Arizona State University, I never expected that my next steps would lead me back to counseling and psychotherapy.

On the evening of my 31st birthday, I was blindsided with relatively sudden news from my partner of 4 years that he wanted a separation. I was nearing completion of my dissertation, and this left me distracted and feeling completely abandoned. I felt that seeking professional counseling would be wise during such a traumatic time to keep myself physically and mentally healthy especially as I needed to prepare to go on the job market. But I hesitated and felt embarrassed. As someone in the field of psychology who (logically) believed in the healing powers and benefits of psychotherapy and counseling, I continued harboring the negative messages about mental illness and the mental health services that I’ve swallowed since childhood.

A lifetime of holding in all the negative messages and images of the mentally ill had left me bloated and mired in misinformation. I now tasted what my mother experienced as I fought against seeking professional help. I did not want to succumb to what I perceived as weakness for seeking support to heal my emotional and psychological pain and injuries. Such stigmatizing messages, when applied to physical pain and injuries, sound absolutely absurd and foolish. For example, I would not hesitate to seek professional help to treat and heal my leg if I injured or broke it. Would we recommend that people who were experiencing chest pains to ignore it or deal with it on their own? Why should society look down on those who seek treatment for emotional or psychological injuries and pain? Having internalized so many lies and half-truths about mental illness, I became my own worst enemy by denying myself acceptance, respect, and the right and access to a meaningful and productive life. Through the process of (p. 151) writing this chapter, I have come to realize that I must surrender my past in order to command my future.

To do so, I let go of the shame that I felt about my mother’s mental illness and my emotional breakdown during college. Until I took responsibility to liberate myself from a lifetime of devaluing and discriminatory messages, I remained a slave to oppressive lies. For example, I recognized that self-reliance and individual strength were characteristics that were strongly valued in North American culture (especially in males). One myth or stereotype that I had to confront, challenge, and shatter was the notion that independent, strong, and brave individuals (especially men) should endure, ignore, or suppress their emotional, psychological, or physical pain. By recognizing and confronting my internalized stigma, I was finally able to benefit from treatment, healing, and growth. With the help of skilled therapists at Arizona State University’s Counseling and Consultation Services and the support of my family, graduate mentors, and friends, I was able to complete the journey that I began as an inspired undergraduate studying psychology at Berkeley. I am now an assistant professor in educational psychology at Texas A&M University.

A major step in overcoming stigma is confronting and conquering it within ourselves. Reliving the memories of my mother’s experiences with bipolar disorder and my experiences with counseling and psychotherapy has been a painful process. But writing this chapter has freed me to overcome a lifetime of negative and discriminatory messages living within me. Only after surrendering to my sorrows, fears, and pain was I able to conquer and slay my own worst enemy, my internalized stigma. Such a rebirth has allowed me to grow into a new stage in my life. Feeling alive and liberated, I can finally live rather than relive.

Having entered this world knowing how it felt to be alone and misunderstood, I now realize that I am connected to a community of others who, personally or through familial experiences, live productive lives in spite of mental illness. I no longer feel alone in darkness as I did when I was a 1-year-old child staying in the hospital ward after surgery. Individuals with mental illness live with extraordinary challenges that most people could never imagine or know. To overcome such challenges requires extraordinary strength, courage, and resilience. In fact, many individuals afflicted with mental illness are able to move toward or maintain mental health through preventive care or through accurate diagnosis and proper treatment. Reflecting on my mother’s experiences since her youth, I now see her as a whole person who lives with great strength counterbalanced by great vulnerability. I am grateful for the lessons of compassion and understanding toward people who encounter extreme emotional or psychological distress, and that includes me. Through speaking of my mother’s life circumstances, I have discovered my voice in a chorus of voices from individuals touched by mental illness.