How to help Asian American seniors affected by the mass shootings

The Monterey Park community showed its resilience at vigils honoring the victims after the tragedy. Around the state, people are memorializing the 11 victims killed there and those in Half Moon Bay, Calif., and other shootings. But healing the psychological wounds of violence intruding on the Lunar New Year celebration will be a long process.

The victims of the Monterey Park and Half Moon Bay shootings were mainly Asian American first-generation immigrants in their 50s, 60s and 70s. And their healing, experts say, will be helped by younger generations checking in on their elders — the ones who were directly affected as well as the ones feeling secondary trauma from seeing violence inflicted on people who look like them.

For many Asian American seniors in particular, talking about their struggles is not easy.

“Some of them have a coping skill that is stoicism,” said Helen Hsu, a psychologist from Stanford University. “‘If I have a problem, I’m not going to talk about it. The best way is to just go on and act like nothing happened.’ ... And yes, you’re strong, you cope that way, but you cannot do that forever.”

One reason for that reaction could be a history of trauma. Another is a lack of mental health education, which leads to people hiding their struggles, Hsu said. Some people may see mental health challenges as a character flaw or as a secret that could bring shame to their family, she said.

And seniors’ challenges with isolation and loneliness can be invisible, said Jessie Li, a therapist with Yellow Chair Collective, a private Asian American mental health organization that provides services in California and New York.

Hsu added that for many Asian Americans, their first contact with the mental health system isn’t until there a crisis. That can either mean “a hospitalization, a complete crash of health or a violent incident,” she said.

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Asian American therapists The Times talked to affirm that it’s difficult to get older generations of immigrants to see a therapist. And even if they’re willing, it can be challenging to find a professional they trust who speak their language and understand their backgrounds. But here‘s what experts want you to know about how a tragedy like this one may affect Asian American seniors, signs of distress to look for, and ways you can support them.

How the mass shootings might affect seniors

Trauma is cumulative, said Phuong Tang, Li’s colleague at Yellow Chair Collective. It’s important to understand that the recent mass shootings add to the fear that has been building in this community since the rise in anti-Asian hate crimes during the COVID-19 pandemic.

The past is a factor too. Some escaped war. Some normalized struggles with dislocation, prejudice or economic struggles after immigrating to the U.S.

For people with a history of trauma, feeling unsafe or insecure “triggers the trauma again” and can make people anxious and hyper-vigilant, said Paul Hoang, founder of Moving Forward Psychological Institute in Fountain Valley.

They may have escaped a home country that was unstable, but after decades of living in the United States found safety and community.

“All of a sudden there’s this shock of this trauma that they were not prepared for,” Hoang said.

After a tragic event, many people are in shock and survival mode. Others may handle it pretty well, Hsu said, but they might be overwhelmed by grief months or a year later when they get an unexpected reminder.

When this happens, it’s important for elders to understand that this is normal.

“I think everyone is very hopeful and wants to bounce back, but realistically that’s not feasible with the amount of grief and trauma we’ve had,” Hsu said. It will take time, she added.

How can you tell if you or your loved one needs help?

First of all, check in. Even if your loved one is resistant to analyzing their emotions in therapy, conversations about how they are feeling start at home, Li said.

If a senior is living on their own, you won’t know what’s happening with their routine or their health unless you give them a call or pay them a visit.

Hoang says the trauma they’ve experienced could trigger depression and result in them isolating themselves. He added that the consequences are higher for seniors who discontinue their daily routines; they could forget to take their essential medicines, for example.

Other things to watch for include:

• Changes in eating habits, sleeping patterns or daily activities.
• Avoiding feelings by downplaying them.
• Minimizing their current feelings by comparing this experience with past ones or other people’s experiences.
• Physical ailments, which can be a way of expressing emotional pain. Saying “my head hurts, my back hurts, or I have stomach pain,” Li said, can be a way to express sadness or trauma.

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Tips for having these conversations

Show support without labeling or stigmatizing, Hoang said.

Some older Asian Americans may not relate to Western ideas of mental health. When you reach out, try limiting your use of clinical mental health terms such as “depression,” “trauma” or “therapy.”

Hsu said there has been a lot of anti-stigma work in the U.S. around how we talk about mental health. But several studies found that messages about mental health being related to brain chemicals or being similar to a physical ailment such as diabetes are not well received by the older Asian American community.

“Because we are familial, it’s like, ‘OK, so you’re saying it’s not my fault, but now you’re saying there’s something wrong with my family’s genes,’” she said.

Instead, focus on using words such as “balance” and “healing.” Send them an article that quotes the same experts in this article, but focus on their balance and healing, and not “mental health” specifically. Ask simple questions, such as, “How are you doing?” and “How can I help?”

Many Asian American cultures believe in holistic health, Hsu said.

“Your mind and your body need to be in balance,” she tells her patients. “So if your mind and body get out of balance, you need to be proactive to get back in balance.”

Talk about cultural or spiritual traditions they might relate to; for example, burning incense in front of altars, wearing colored cloths on their arms for 100 days of mourning or celebrating ancestors at the Ching Ming Festival.

If the person you’re checking on is open to talking but doesn’t feel they can speak with you, encourage them to talk to a trusted person — that can be a community leader, a pastor or another family member.

If they’re open to it, share local resources and information on mental health services.

Also give them space to grieve privately.

What else to try

The reality is that talk therapy doesn’t work for everyone, Tang said.

Helping your elders with their mental health can also include the basics, like making sure they are maintaining a routine of eating well and getting enough rest.

Finding a community that elders can socialize with is also key to coping in a healthy way. When they’re ready, help them participate in community healing activities: a vigil, for example.

There are other types of more group-oriented therapy like art therapy or music therapy. When thinking about the Monterey Park ballroom dance community, Tang thinks movement-based healing could be more fitting. Tailor your suggestions to their interests.

Lastly, Hoang and Tang emphasize that if a tragic incident happens in a sacred space, it’s critical for people to reclaim the activities they love — where they can socialize, find joy and heal. This will reduce the risk of post-traumatic stress disorder, he said.

“If that activity is taken away from them, they will lose their identity,” Hoang said. “They will lose their only coping skill. And that’s worse than the trauma.”

Remember that there were many great memories before the incident, and be proactive in creating new great memories, said Tang.