News Detail

Marsha Linehan explains how Radical Acceptance was ultimately rooted in Buddhist philosophy and translated into behavioral language, in this WHYY story about Chinese elders learning to "walk the middle path" to better mental health.

Chinese elders ‘walk the middle path’ to better mental health

By Liz Tung and Jad Sleiman

It’s a Friday morning, and the Selfhelp Benjamin Rosenthal Senior Center in Flushing, Queens is bustling with activity.

In one room, around two-dozen Asian seniors are practicing tai chi. Nearby, another group rehearses an opera, their voices rising above the reedy twang of traditional Chinese instruments.

But Jane Qiu, the program director here, says Selfhelp’s seniors weren’t always so engaged.

“By observation, I can see some members, when they came here, were so sad and just crying,” Qiu says. “And now they are just involved in all activities, smiling. You can see their faces here, just fewer couch potatoes.”

Selfhelp is one of 25 senior centers in New York City’s Thrive NYC initiative, an $850 million effort to expand mental health access to a wide range of New Yorkers. The program could prove especially important in neighborhoods like Flushing, where Asian — and especially Chinese — immigrants make up a majority of the diverse population. That’s because, according to recent research, Asian seniors living in the United States may be more at risk for psychological distress than public health officials once thought — and less likely to seek help.

“We’ve been seeing a tremendous amount of depression, anxiety, sense of hopelessness, stress, as well as suicidal ideations,” says XinQi Dong, a geriatric physician and researcher, who heads the Rutgers Institute for Health, Health Care Policy and Aging Research. “The numbers are much higher than we anticipated.”

Dong is one of the lead researchers of one of the largest cohort studies in a Western country focused on the health and well being of ethnically Chinese seniors. He says it isn’t just psychological distress that plagues Chinese seniors in the United States — it’s a cultural stigma against mental health issues and treatment.

“There’s a great deal of shame and misbelief associated with having mental illnesses,” he says. “I think from a culture perspective that stigma and the sense of helplessness exacerbates those conditions.”

Family and mental health distress

Dong says researchers are still figuring out what causes the relatively high levels of mental distress among Chinese seniors, but they’ve identified a few.

He says acculturation issues related to immigration can affect mental and physical health, as can neighborhood conditions that affect safety, access to services, and community cohesion.

But Dong says one factor stands out: family.

“Family conflict, issues of emotional closeness, social interactions, elder abuse-related issues are strongly associated with mental health,” he says...

Finding solutions in dialectical behavior therapy

It’s a familiar story for 66-year-old Yufen, a regular at the Flushing center. She asked that her last name not be used to protect her privacy.

Yufen was never kicked out of her home, but says she knows the toll that family conflict can take.

“I felt like I couldn’t find the power to keep living,” she says, sitting in a quiet meeting room at the center. “I would sit on that bench outside with tears rolling down my cheeks. Even now, it’s painful thinking back on how I was feeling then. I didn’t want to eat; I couldn’t sleep.”

As Yufen’s depression deepened, her sister began to take notice. She began taking Yufen to the senior center in Flushing, hoping that the activities there would brighten her mood.

It was on one of those visits that Yufen spotted a poster advertising a new class.

“Please join in our all-new evidence-based course — Dialectical Behavioral Skills Study Group,” the poster read. “Learn effective skills for increasing control over your mood and behavior in the face of life’s challenges and hardships!”

The class was actually a therapy group, though you wouldn’t have guessed it from the poster.

Officials with the New York City Department for the Aging learned early on that directly advertising mental health services didn’t work very well. There was too much stigma among seniors — especially among Asian immigrants.

“There’s some taboo if you have mental problems,” says Selfhelp director Jane Qiu.

 Many like Yufen weren’t used to even considering their mental health.

“For a lot of the seniors, they may grow up never getting in touch with their emotions,” says Yuanyuan Hu, a counselor who provides treatment at Selfhelp. “In the first beginning, we were having difficulty, but we had the idea this [therapy approach] may work.”

The approach they’d adopted offered another way of connecting with the seniors — cultural appeal. The poster described a class with an emphasis on interpersonal harmony, on integrating mind and body, and on the balance between reason and emotion — all familiar concepts in many Asian countries.

Dialectical behavior therapy was invented in the 1970s by psychologist Marsha Linehan , as part of her effort to develop a treatment tailored to suicidal patients dealing with what’s now known as borderline personality disorder.

The disorder is marked by unstable moods and low self-image, as well as a tendency to perceive criticism where none may exist. In interviews, Linehan describes how her patients would react when she pushed them to identify harmful thoughts.

“They would either get angry with me, hide behind a chair, storm out, quit therapy, yell and scream, cry, or say they were going to kill themselves,” she says in a video on the YouTube channel called Borderliner Notes .

During a visit to a Buddhist monastery, Linehan had a light bulb moment about the key to treating these patients — an idea that she termed “radical acceptance.”

Read the entire article here .