Introduction
Although the rise of the COVID-19 pandemic has brought anti-Asian sentiments to the forefront of public consciousness, Asian Americans have long been cast as "perpetual foreigners" in a centuries-old history of discrimination.[1-3] The Trump administration's and many popular media sources' politicization of COVID-19 as the "Chinese virus" and "Kung flu," alongside the recent uptick in anti-Asian hate crimes, have only added fuel to an ongoing flame of xenophobia that dates back to the nineteenth century and has had lasting repercussions on the mental health of Asian Americans.[4]
History of Anti-Asian Racism: 1800s to Present
When the first wave of Chinese immigrants came to America during the California Gold Rush, they were harassed as foreigners who had come to take American jobs away, culminating in the signing of the Chinese Exclusion Act in 1882 which halted Chinese immigration for ten years and barred existing Chinese immigrants from naturalization.[5] During this ban, Chinese Americans were prohibited from interracial marriage and segregated into Chinatowns as the numbers of Chinese in America dwindled.[6] In the years following the ban, other Asian American groups faced yet more brutal discrimination. In 1930, Filipino American farm workers were assaulted and lynched by local California residents opposed to Asian immigration during the Watsonville Riots.[7] During World War II, hundreds of thousands of Japanese Americans were wrenched from their homes and imprisoned in internment camps across the western United States while racist caricatures circulated wartime propaganda.[8]
Even after the doors were reopened to Chinese immigration in 1943, anti-Asian xenophobia has persisted into modern history and held a lasting impact on the mental health of Asian Americans. With the SARS (Severe Acute Respiratory Syndrome) outbreak in Asia in 2003, Asian Americans were often stereotyped as "dirty" or "disease-ridden foreigners," despite how long they had lived in the U.S.[9] These labels have resurged with the emergence of COVID-19. After the first outbreaks of the coronavirus in Wuhan, China, and its rapid spread around the globe, many Americans began scapegoating China for the pandemic. When news broke out that the disease had likely originated from an open-air wet market in Wuhan, outrage arose over the unsanitary conditions for meat and live animals that left the door open for zoonotic viral transmission.[10] This outrage snowballed into a form of hygienic racism that exacerbated stereotypes of Asian Americans as "dirty" and "disease-ridden," where tropes such as Asians "eating bats" from "filthy markets" were weaponized to shame China for practices that contributed to the pandemic.[11] With the eye of blame on China, people increasingly targeted any Asian American perceived to resemble a Chinese person, a dangerous generalization known as racial profiling that often accompanies hate speech and racial violence.[12,13]
COVID-19 Discrimination
Startling numbers of anti-Asian hate have been reported in the two years since the pandemic began. During the first two weeks of the pandemic, 1,135 experiences of discrimination and harassment against Asian Americans were reported.[14] By December 2021, nearly two years since the pandemic's start, this number had risen to 10,905 reported hate incidents.[15] This problem has only been exacerbated throughout that time, with 42.5% of these incidents occurring in 2020 and 57.5% in 2021–a 15.2% increase.[16] Anti-Asian hate has taken many forms during the pandemic. Hate incidents have ranged from verbal harassment and xenophobic insults (such as the phrase "go back to your country"), to job discrimination and property vandalism, to being coughed on and physically assaulted.[17]
Asian American elders are often the most vulnerable to violent attacks, and have made up the majority of prominent anti-Asian hate headlines. As reported by Bloomberg Equality, in 2020, 84-year-old Rong Xin Liao was kicked in the chest while using his walker in San Francisco. In April 2020, an attacker in New York stomped on the head of 61-year-old Yao Pan Ma, who was collecting cans. Ma died eight months later on December 31, 2020. In May of 2021, two senior Asian women were stabbed at a bus stop in downtown San Francisco after going afternoon shopping. The prevalence of these attacks can cause Asian American elders to feel frightened to leave their homes, which has led to difficulty getting necessities such as food and exercise.[18] The prolonged alienation and pain of seeing one's own elders brutally assaulted can be severely traumatic, and as put by National Alliance on Mental Illness CEO Daniel H. Gillison, Jr., the "effects of racial trauma on mental health are profound and cannot be ignored."[19]
Effects of Racism on Mental Health
Racism is extremely detrimental to mental health, and its effects are widespread in Asian American communities. A 2021 mental health report by the activist group Stop AAPI Hate revealed that 1-in-5 Asian Americans who have experienced racism display racial trauma, or severe psychological and emotional harm caused by racism. Racism and discrimination are highly correlated with stress, adverse health outcomes, and psychopathology, as well as a hesitancy to seek professional psychological help.[20] In Asian Americans, this has been seen to manifest in heightened symptoms of depression, anxiety, PTSD, suicidal ideation, and higher risk for substance abuse.[21,22] Beyond diagnosable mental health conditions, sustained discrimination can also result in more insidious harms to everyday wellbeing, including subclinical stress responses such as fear and sleep disturbances that can last for months and even years.[23]
Being constantly demeaned as "foreign" and the cause of a disease additionally produces a form of traumatic stress that can be pervasive. The perpetuation of witnessing anti-Asian violence often leads to individuals internalizing other victims' trauma, a situation known as vicarious trauma.[24] The chronic stress and fear of endangerment resulting from vicarious trauma can predispose Asian Americans to experience long-term symptoms comparative to PTSD, such as hypervigilance, anxiety, persistent fear, anger, guilt, or shame.[25] In fact, Stop AAPI Hate's 2021 mental health report found that Asian Americans who have experienced racism feel more stressed by anti-Asian violence than about the pandemic itself, an anxiety that follows them into re-entering school and jobs as the pandemic begins to become normalized.[26] The compounding of severe xenophobia on top of a deadly pandemic burdens Asian Americans with a heavy and unjust weight to bear when their focus and energy should be centered on remaining healthy.
Insidious Racism: Microaggressions and Gaslighting
Underlying more easily visible forms of racism are microaggressions, commonplace daily indignities that carry "hostile" or "derogatory" undercurrents toward their target, whether intentional or unintentional.[27] Microaggressions against Asian Americans tend to fall into several categories, which are by no means finite or fully independent of one another. One such category includes assumptions of inferiority, which can include statements or actions indicative of beliefs that all Asian Americans are foreigners, second class citizens, or criminals. Another category is exoticization, as evidenced by several brands, businesses, and caricatures oversexualizing Asian women.[28] Microaggressions additionally tend to ascribe to racial profiling through assumptions of similarity, making generalizations that invalidate interethnic differences (e.g., all Asians look the same; all Asians are intelligent). Other microaggressions can relate more to the environment in which they occur against Asian Americans, such as hostile comments in the workplace or school, as well as avoidance and disdain towards Asian businesses and restaurants.
Such subtle forms of discrimination can be quite insidious; because they often happen quickly (e.g., through offhand comments) and appear innocuous, it becomes difficult to react or even realize that the behavior was distressful and discriminatory.[29] In fact, the microaggression of microinvalidations gives rise to gaslighting, in both self- and societally-inflicted forms. Microinvalidations occur when Asian Americans' shared experiences of cultural friction or discrimination are discounted by others or made to seem like exaggerations–such as being told that they complain about race too much or that people of color do not experience racism anymore. Such sayings render one's experiences illegitimate and even invisible, which can lead Asian Americans to question the validity of their perceptions of reality. Doing so is a form of manipulation, i.e., gaslighting.
Within-Group Differences
It is important to also remember that Asian Americans are not a monolith, and experiences of discrimination can compound and vary widely based on a person's unique intersection of identities. For Asian American women, anti-Asian hate has been particularly vehement: 74% of Asian American and Pacific Islander women respondents reported experiencing racism and/or discrimination over the past year, with 53% of perpetrators being a stranger, according to the National Asian Pacific American Women's Forum's 2022 State of Safety Report.[30] This number is up from previous years, with over half of women respondents reporting that they feel less safe today than when the pandemic first began and the majority of reports of discrimination being made by women.[31]
This data additionally comes one year after the 2021 Atlanta spa shootings, where six out of eight murder victims were women of Asian American descent.[32] With the shooter's motivation cited as the "temptation" of massage parlors, Asian American women face a unique experience of hypersexualization and exoticization through the intersection of their gender and cultural identities, which renders them more susceptible to adverse mental health effects. In fact, Asian American women report more negative mental and physical outcomes than men when exposed to a lower threshold of discrimination, demonstrating the greater impact of the discriminations against their compounding identities.[33]
Different levels of discrimination also exist based on environment. In the workplace, those without college degrees report poorer mental health scores alongside more exoticization and assumptions of similarity, while those with college degrees report more microinvalidations and workplace microaggressions.[34] Degrees are associated with different job experiences, causing different stereotypes–such as exoticism or assumption of intelligence–to become more present. Higher levels of education have also been correlated with greater perception of discrimination, due to a greater level of contact with white people as well as heightened racial awareness.[35]
In schools, discrimination can often take the form of racial bullying, which has been on the rise with the onset of the pandemic and the spread of racist jokes about who carries the disease.[36] Racism can be particularly harmful for youth, who sit at a critical point in the development of their self-esteem and body image. When phenotypic features of Asians are ridiculed, Asian American young adults have been shown to experience body dissatisfaction and body shame, even after adjusting for controls like body mass index. The association between higher levels of racism and lower levels of self-esteem apply to ostracization as well: xenophobia often leads to exclusion of Asian Americans from social groups and activities in schools, and is shown to increase their self-consciousness, discontent, and shame about their body image.[37]
The ostracization of Asian Americans in classrooms and workplaces often coincides with being a small minority in a class, which leads to some regional differences in experience of discrimination. In parts of the United States that have fewer Asian Americans, such as the Midwest, higher levels of microaggressions, assumptions of inferiority, exoticization, and assumptions of similarity are reported than on the West Coast.[38] This may be attributed to the fact that both the depth of Asian American history and the actual volume of Asian Americans are much greater on the West Coast than in other areas of the United States. The more familiarity and interactions with Asian Americans there are, the more harmful stereotypes are disproven and replaced with genuine relationships, an idea which could be implemented to help counter xenophobia in other areas of the U.S.[39]
Ways to Combat Anti-Asian Hate: Culture, Therapy, and Policy
To aid in countering stereotypes, Misra & Le (2020) recommend presenting these generalizations as "unrepresentative or atypical." For example, to disprove the stereotype that individuals who look like they are from China are more likely to spread COVID-19, the media could disseminate images of Asian Americans who actively combat the spread of COVID-19 as frontline medical workers–an intervention that "has shown efficacy for reducing stigma previously."[40] In challenging social norms around race, Canady (2021) also discusses encouraging prosocial and proactive antiracism, which can include education about racial consciousness, advocacy for marginalized groups, and reactive bystander interventions. By confronting hate incidents and supporting victims afterwards, community members can foster a sense of solidarity and ease the pressures of isolation and ostracization associated with xenophobia.
For Asian Americans themselves, community can be particularly important in easing the mental burden of racial discrimination. In fact, research has found that sharing stories about one's racial discrimination experience is a protective factor for long-term traumatic stress in reaction to racial discrimination: about 28% of Asian Americans who experienced racial trauma after a hate incident no longer met criteria for race-based trauma after reporting their experience to Stop AAPI Hate.[41] It follows that it is important to openly discuss and understand the stories and histories of anti-Asian discrimination. Although disclosure can be hampered by cultural values and the minority myth, when Asian Americans are able to disclose their experiences to support groups and therapists, they are able to lift some of the burden of isolation.
A healthy and supportive relationship with a therapist is then similarly important in navigating racial trauma. To best support Asian American clients, therapists should practice culturally competent therapy and maintain education and awareness on the intersectionality of identities.[42] Traditional Western psychological interventions tend to focus on what individual victims can and should do to combat their reactions racism, rather than "contextualizing individuals' vulnerabilities and reactions to sociocultural and structural disadvantages" in seeking broader ways to rectify the root causes of discrimination.[43] By doing so, they place a burden on individual victims who are already disadvantaged and strained by discrimination that can edge toward invalidating their experiences, gaslighting, and victim blaming. Similarly, therapists sometimes gaslight clients' experiences of racism through labeling seemingly "invisible" microaggressions that cannot be "proven" by a client as the results of being "too sensitive" or "paranoid."[44] Doing so is a microinvalidation itself that can be damaging to both the therapeutic alliance and the wellbeing of Asian American clients, demonstrating the need for therapists to cultivate cultural empathy and participate in education on culturally competent treatment.
Finally, policy interventions have the potential to enact the widespread change that individual and community actions cannot. During the SARS pandemic of 2003, the American Center for Disease Control led an initiative to counter anti-Asian sentiments by monitoring stigma in the public and media while collaborating with Asian American activists to create "culturally tailored" interventions.[45] To address the uptick in anti-Asian hate crimes, the federal government should look to the bigger picture of the long history of anti-Asian violence and enact similar interventions as in 2003. By investing in culturally appropriate mental health services and community-based outreach to the Asian American communities most affected by COVID-19 discrimination, the government can collaborate in cultivating culturally resonant responses that best combat the harm done to Asian American communities.
Ultimately, whether overt or insidious, historical or current, anti-Asian racism has been extremely detrimental and often traumatic to the mental wellbeing of Asian American communities. In the face of the current pandemic-driven surge in anti-Asian discrimination, it is imperative to learn the history of the Asian American experience, listen to victims' stories, and foster discussion around available mental health resources. By cultivating empathy and standing up against discrimination wherever we see it, we can help build a more supportive, anti-racist, and healthy community.
If you or someone you know has experienced anti-Asian discrimination, you are not alone. You can report anti-Asian discrimination here at https://stopaapihate.org/reportincident/.
For further mental health resources and community organizations addressing anti-Asian discrimination, please visit https://stopaapihate.org/resources/.
For more information, click here to access an interview with Sociologist Peter J. Stein regarding genocide and discrimination.
Contributed by: Anna Kiesewetter
Editors: Jennifer (Ghahari) Smith, Ph.D. & Brittany Canfield, Psy.D.
References
1 Misra, S., Le, P. D., Goldmann, E., & Yang, L. H. (2020). Psychological impact of anti-Asian stigma due to the COVID-19 pandemic: A call for research, practice, and policy responses. Psychological Trauma: Theory, Research, Practice, and Policy, 12(5), 461–464. https://doi.org/10.1037/tra0000821
2 Nadal, K. L., Wong, Y., Sriken, J., Griffin, K., & Fujii-Doe, W. (2015). Racial microaggressions and Asian Americans: An exploratory study on within-group differences and mental health. Asian American Journal of Psychology, 6(2), 136–144. https://doi.org/10.1037/a0038058
3 Cheng, H. L. (2020) "Xenophobia and Racism Against Asian Americans During the COVID-19 Pandemic: Mental Health Implications," Journal of Interdisciplinary Perspectives and Scholarship: Vol. 3, Article 3. https://repository.usfca.edu/jips/vol3/iss1/3
4 Ibid.
5 Yi, V. (2016, February 9). Model minority myth. The Wiley Blackwell Encyclopedia of Race, Ethnicity, and Nationalism. Retrieved February 22, 2022, from https://www.academia.edu/21743155/Model_Minority_Myth
6 Nadal et al., 2015
7 Ibid.
8 Yi, 2016
9 Misra & Le, 2020
10 Chuvileva, Y. E., Rissing, A., & King, H. B. (2020). From wet markets to Wal-Marts: tracing alimentary xenophobia in the time of COVID-19. Social anthropology: the journal of the European Association of Social Anthropologists = Anthropologie sociale, 10.1111/1469-8676.12840. Advance online publication. https://doi.org/10.1111/1469-8676.12840
11 Ibid.
12 Misra & Le, 2020
13 Cheng, 2020
14 Misra & Le, 2020
15 Yellow Horse, A. J., Jeung, R., & Matriano, R. (2021, December 31). Stop AAPI Hate National Report. Stop AAPI Hate. Retrieved March 14, 2022, from https://stopaapihate.org/national-report-through-december-31-2021/
16 Ibid.
17 Cheng, 2020
18 Bloomberg Equality
19 Canady, V. A. (2021, March 26). Field condemns hate‐fueled attacks of Asian Americans, offers MH supports. Wiley Online Library. Retrieved February 22, 2022, from https://onlinelibrary.wiley.com/doi/10.1002/mhw.32736
20 Ibid.
21 Misra & Le, 2020
22 Cheng, 2020
23 Nadal et al., 2015
24 Cheng, 2020
25 Ibid.
26 Saw, A., Yellow Horse, A., & Jeung, R. (2021, May 27). Stop AAPI Hate Mental Health Report. Stop AAPI Hate. Retrieved March 16, 2022, from https://stopaapihate.org/mental-health-report/
27 Nadal et al., 2015
28 Ibid.
29 Ibid.
30 Pillai, D. & Lindsey, A. (2022). The State of Safety for Asian American and Pacific Islander Women in the U.S. National Asian Pacific American Women's Forum, Washington, DC. https://www.napawf.org/assets/download/napawf-state-of-safety-report.pdf
31 Yellow Horse et al., 2021
32 Canady, 2021
33 Nadal et al., 2015
34 Ibid.
35 Ibid.
36 Cheng, 2020
37 Ibid.
38 Nadal et al., 2015
39 Misra & Le, 2020
40 Ibid.
41 Saw et al., 2021
42 Canady, 2021
43 Ibid.
44 Nadal et al., 2015
45 Misra & Le, 2020