Mental illness is isolating no matter where you are in the world. There is always stigma, whether it be around saving face or from fear or lack of education, and it can be so easy to feel completely alone at a time when you need company the most. In Vietnam this is no different. Words and illustration by Zoe Osborne.
“The official statistic for mental illness here is something like 15 to 20 percent of the population, but in reality it is much, much more,” says Ngo Minh Uy, Director of Psych Cafe and Director-General at psychological service company WeLink. “People just either don’t realise that they are sick, or they don’t want anyone to know.”
I meet with Uy at Psych Cafe in Saigon’s District 11, a place for students and professionals in psychology to come and network. As we sit in his cafe, he tells me about the situation here; how Vietnamese culture can both lead to, and exacerbate mental illness, and how the current options for psychological care and education are so very limited.
One of the first things Uy brings up is the importance of ‘saving face’ to Vietnamese society. “People often don’t feel safe to talk to their families about their problems,” he says, “because the family, especially the parents, will judge them. There are limited facilities for support here, aside from hospital clinics and places like Psych Cafe, so most people will depend on their friends for help.”
Does this kind of stigma also contribute to the development of mental illness? Surely such an emphasis on ‘keeping things quiet’ can’t be healthy. The answer is yes, it does, and no, it isn’t, especially amongst young people. According to a 2013 public health study by Bio Med Central on Vietnamese secondary school students, rates of anxiety and depression amongst the nation’s young people were as high as 41.1 percent.
The study found that the most common causes were isolation and emotional abuse from the family, and high educational stress. Almost 80 percent of the students interviewed suggested a need for confidential academic counsellors, and that the attitudes of their parents and teachers needed to change. “It can be so competitive here,” says Uy. “People invest a lot of money and energy into their children, pushing them very hard. Students feel that they absolutely MUST be successful, and anything less than perfect is just not good enough.”
Another big contribution to anxiety and depression among young people in this country is the traditionally rigid and respect-based family structure. “The idea that younger ones are lower than the older ones can be so harmful to young people as they grow up. Children aren’t encouraged to think for themselves—neither at school nor at home—and families make many of their decisions for them. Then when they leave home, they must suddenly think and choose for themselves.”
Uy goes on to explain how the emphasis on saving face also causes tension between married couples and partners: “So many problems are left unsaid because they get swept under the carpet. I work with a lot of couples and families, and so often the people I counsel find it hard to talk directly to one another.”
According to a 2016 survey by market research company Turn Insight Into Action (TITA), only 25 percent of the 400 Vietnamese married citizens interviewed said they were “very happy” in their marriage, and 99 percent admitted a decline in happiness with the relationship as time went on. According to Uy, this kind of decline is very much related to the idea of pride and an inability to communicate.
According to Basic Needs, an international NGO working to improve the lives of people living with mental illness, although Vietnam has a National Mental Health Program in place, it only covers 30 percent of the country’s communes, and treatment is only available for a limited number of illnesses. “There are two main problems here,” says Uy. “Firstly, many patients think that you can come to a counsellor once and they will cure you. But obviously this isn’t the case. It takes time.”
According to Uy, student education in psychology is also an issue. “Most courses in psychology here focus on Marxist philosophy, but psychology is not political. It is personal and scientific, and to really understand the discipline you have to study a wide range of facts and perspectives. Students are also often too lazy to spend the time required to get a real grasp on the discipline, so they take short, incomprehensive courses.”
WeLink and Psych Cafe are both part of a bigger puzzle working to change this. The two organisations work together to provide psychological services for patients, while acting as a source of education for people studying the discipline, in order to promote a more rounded, scientific way of approaching psychology in Vietnam.
Life as an Expat
Integrative therapist Naomi Taylor grew up as an expat, and now works with expats in Asia, originally out of Jakarta and Beijing, and now Saigon. “An expat life can be isolating for some, and an expat life can also be filled with opportunities to engage with those around. It does depend on the individual,” she says.
A 2012 study from the International Journal of Mental Health found that a high demand for adjustment is a leading cause of mental illness among expats. “It is also not unusual to meet expats who struggle with transition. A sense of loss is often experienced and this can be tough on people, very tough,” says Taylor. “Another common area of difficulty is when one partner in a relationship misuses the trust that the other has privileged them with. Communication breakdown is often a major contributor to this.”
Taylor has a lot of experience working with expat families, and though she notes that many family tensions would exist regardless of their overseas status, the expat way of life can really enhance them. “As an expat you have the added ingredients of the absence of family or friends; perhaps one parent [is] travelling more frequently, leaving the other feeling like a single parent much of the time; helpers in the home and children being unwilling when asked to contribute. With greater finances and richer experiences can come a desire for more… and more.”
Taylor grew up in an expat family herself, so I ask about her own experience as a third-culture-kid. “Where to start!” she replies. “I was seven when I first moved away from my home country, and remember just really missing everything from home at first. I do have fond memories of so many wonderful cultural experiences [however], and life was good on the outside, but of course behind closed doors there is always another story. Friends coming and going; supportive yet also envious family back home; extramarital affairs and divorce within the family et cetera.”
Finding support so far from home can be difficult, but there are a number of options for expats in Vietnam. “Honestly, I find word of mouth is usually the most helpful,” says Taylor. “Most international clinics will have a therapist attached to them. Some counsellors will provide Skype sessions, though my personal opinion is that face to face is by far the greater option for therapeutic support, there are less obstacles when building trust.”