Overcoming the Wall of Silence Around Suicide in the Asian American Community

In 2004, Iris Chang Killed Herself
(and So Did over 29,999 Other Americans)

By Descartes Li, M.D.

With her work, Iris Chang represented a new concept of openness and honesty in the Asian American community. She deplored the denial and collective amnesia of the Japanese atrocities in Nanking during World War II. Unfortunately, mental illness remains taboo topic. But perhaps, in openly talking about suicide in general and her suicide in particular, that spirit of remembering, and of refusing to forget, will live on.

            Suicide is surprisingly common among all Americans, including Asian Americans. In the United States, more than 30,000 people commit suicide every year. Think about that number: 30,000. It’s such a large number that it’s hard to grasp. It’s greater than the total population of the town that I grew up in. It’s greater than the total student body of the college I graduated from. It’s ten times the number of people who died in terrorist attacks on September 11. In the age group of 15 to 24-year-olds, suicide is the third leading cause of death, after accidents and homicide. But 30,000 only represents the tip of the iceberg: the number of people who were successful in their attempts to commit suicide. Many more people have attempted or seriously considered suicide. In large-scale surveys, about 4 percent of the general population have made an actual suicide attempt, and about 16 percent have had thoughts about committing suicide.

           Suicide rates in the U.S. by decade have been relatively stable, but several studies have shown how a single suicide can trigger an “epidemic” of copy-cat suicides. (In sociological circles, this is known as the “Werther effect”). So when I saw the beautiful face of Iris Chang on the November 18, 2004 edition of AsianWeek, I worried about other readers who, rather than see a tragic loss, actually see an inspiration to commit suicide too.

As an Asian American psychiatrist, I am frequently asked: “Are Asian Americans more likely to commit suicide than other Americans?” Asians are often associated with the Japanese practice of seppuku, a ritualized form of suicide. However, most large-scale, population-based studies indicate that Asian Americans, including Japanese Americans, do not commit suicide at a higher rate than other ethnicities here in the U.S. In addition, Asian Americans generally have a low rate of gun ownership, and more than half of all suicides are associated with firearms. However, as Iris Chang’s suicide with a an antique handgun illustrates, Asian Americans can still buy firearms. There are, furthermore, several factors that do predispose Asian Americans to suicide.

While no ethnicity conforms perfectly to stereotypes, there is a certain percentage of Asian Americans who meet the image of the hard-driving, success-oriented, perfectionistic model minority who doesn’t show weakness or talk about emotions.  People who meet this image (Asian American or otherwise) are particularly vulnerable to suicide and suicidal thoughts.  The Asian virtue of stoicism, which prohibits the discussion of certain taboo or uncomfortable topics, including mental illness and suicidal thoughts, increases the risk of suicide.  Thus, it is common for Asian Americans conceal symptoms of mental illness from others until it is too late.  It is painfully ironic to me that Iris Chang, an Asian American advocate for an open discussion of history, should be the victim of suicide, in which the risk factors of isolation and withdrawal frequently figure so prominently. 

In addition, in the single-minded pursuit of “success”, setbacks or failures are often seen as catastrophic disasters.  Perfectionistic personality traits which often lead to high achievement also can lead to an “all-or-nothing” style of thinking:  either you succeed or you fail.  Since the individual can’t talk about it with others, they often do not obtain differing perspectives on the situation.  The idea that “I’m a failure”  or “There’s no hope” takes on an awful reality.  And just like other Americans, Asian Americans can be fiercely independent with a philosophy of “solve your own problems, don’t depend on anyone else.”

            Some people believe that everyone has the right to commit suicide.  However, most suicidal people are at least ambivalent about killing themselves.  The idea of suicide usually comes and goes, and the vast majority of people who have attempted suicide in the past are glad to be alive today.  Moreover, most studies show that more than 95 percent of people who committed suicide suffer from a treatable psychiatric disorder.  While there are individuals with a terminal illness who, after thorough and thoughtful consideration, do decide to end his or her life, most suicides occur in the presence of severe depression, when the individual’s capacity to make reasonable assessments about life, death, and the future is severely impaired.

            Ideally, suicidal individuals should be seen by a mental health professional for a thorough assessment and evaluation.  Many suicidal individuals worry that they will be hospitalized if they reveal their suicidal thoughts.  But given that 16 percent of the general population has thought about suicide, there’s no way they could all be accomodated in the hospital setting.  A person is hospitalized only if there is no other way to guarantee his or her safety.   Also, even if the person is hospitalized, it is always considered a temporary measure, until other, more permanent solutions can be found.  If you, or someone you know, are thinking about suicide, the most important thing you can do is to start talking about it.  We can all help overcome the wall of silence around suicide.  Call your doctor, tell your friends or family members, telephone your local suicide prevention hotline, talk to your pastor, priest, monk, rabbi or other respected individual.  You can also surf the Web for more information and resources.  A good example is: http://www.psycom.net/depression.central.suicide.html.

            Organizations like NAWHO are crucial in efforts to detect and treatment mental illnesses, like depression.  You can also do more by supporting organized suicide detection and prevention efforts.  These include the Iris Alliance, the National Alliance for the Mentally Ill, Suicide Awareness/Voices of Education (SAVE), and the American Foundation for Suicide Prevention.  Visit their websites, participate in their programs, and donate money. 

            Iris Chang believed that the atrocities committed in war should not be forgotten or covered over.  Overcoming collective denial was her greatest gift to us.  May we all live up to that legacy.

Suicide Risk Factors

History of suicide attempts

Suicidal plans and preparations

Hopelessness

Psychiatric disorder, including substance abuse

Severe symptoms of anxiety or depression

Presence of a firearm in the home

Isolation and withdrawal

Descartes Li, MD
Associate Professor of Psychiatry
University of California, San Francisco
San Francisco, CA
Descartes Li is an Attending Psychiatrist at the Langley Porter Psychiatric Hospital and Clinics at the University of California, San Francisco. He is Director of the UCSF Bipolar Program. He teaches both medical students and psychiatric residents at the UCSF School of Medicine, with a particular expertise in the impact of cultural issues on mental health. He also gives presentations on mental health issues, both locally and nationally. In addition, he is a member of the American Psychiatric Association and the Northern California Psychiatric Society Committee on Asian American Issues.