Cultural Reflexivity in Mental Health Research to Frame Asian American Health and Well-Being

Background and Purpose: Asian American mental health disparities research has largely been framed using theoretical lenses of social capital (Snowden, 2005), cultural health capital (Shim, 2010), and social determinants of health (Marmot, 2005). Disparities research has elucidated underlying barriers to mental health services in the U.S. including a lack of culturally and linguistically competent providers, lack of health insurance coverage, and cultural stigma (Sue, Cheng, Saad, & Chu (2012). While detecting and mitigating such barriers is critical, an evaluation of the social construction of the mental health system, including mental disorders and subsequent therapies, is necessary to prevent further marginalization of Asian American communities.

Methods: This paper applied a Foucauldian lens to critically examine discourses promoted by existing disparities-focused research and practice frameworks at the intersection of three topics: mental health disparities, Asian American populations, and the mental health care system. Questions guiding this critical discursive analysis were: 1) how are Asian Americans constructed as an object served by the mental health care system; 2) what subjectivities are available to those experiencing mental health issues or disparities; and 3) how do these object and subject constructions intersect with larger discourses around mental health and the mental health care system? This study highlighted the utility of cultural reflexivity as a methodological intervention to inform analysis of empirical literature.

Results: Findings revealed implicit goals in positivist mental health disparities discourses that connect Asian Americans to a taken for granted system of disorders and services that may or may not benefit them. Comparisons to non-Latino whites as a reference point to measure progress on service use, prevalence of disorders, and medication usage were evaluated based on normative discourses such as “underutilization” to report Asian American behaviors. Findings suggest the disparities framework is insufficient because of the ontological and epistemological dominance of mental illness and mental healthcare, and comparisons to non-Latino whites. These empirical comparisons imply we are observing “truths” and revealing subsequent discrepancies of these truths found between racial groups. Consequentially, it becomes worth asking who frames which social practices are considered legitimate, natural, or healthy – often well-meaning researchers, providers, and public health advocates in positions of power and authority (Aronowitz, Deener, Keene, Schnittker, & Tach, 2015). Usefulness of terms like “mental illness” and “mental health services” were re-considered. Focusing on a positivist empirical lens reporting markers determined by one majority cultural group serves to perpetuate dominant structures of knowledge-making that may not serve Asian Americans.

Conclusions and Implications: Cultural reflexivity is a necessary methodology to uphold indigenous values, beliefs, and practices that promote well-being and mitigate mental health conditions within marginalized Asian American communities. To avoid reducing such notions to generalized conceptualizations, culturally competent approaches require investing time in community based participatory action. Partnerships with faith based organizations and cultural centers as well as incorporating integrated mental healthcare such as complementary alternative therapies are recommended (Sarris, Glick, Hoenders, Duffy, & Lake, 2014).