NEW YORK -- The patients may suffer from classic mental ailments: depression, anxiety, schizophrenia.
But as they make their way to a sprawling mental hospital in northeast Queens, they also complain of problems that the average New York City psychologist has rarely encountered: pa-feng, a phobic fear of wind and cold that occurs in Chinese patients; hwa-byung, a suppressed anger syndrome suffered by Koreans; and Latah, a Malaysian and Indonesian psychosis that leads to uncontrollable mimicking of other people.
They are the kinds of illnesses that psychologists refer to as culture-bound syndromes. Experts say that while they are fairly common among New York's exploding immigrant population, they are often undiagnosed, or are confused with other conditions. But a growing number of mental health professionals are now focusing on patients' ethnicity and country of origin to treat mental illnesses.
Westerners have their own culture-bound syndromes. Anorexia nervosa, for example, most often afflicts young women exposed to movie and television images of an idealized skinny female body.
Treating 40 patients
But immigrants tend to have poor access to mental health care and until recently, there were few mental health services like the new program in Queens, the Asian-American Family Clinic at Zucker Hillside Hospital. Dr. Yong Cho and Dr. Quixia Mei Lan opened the clinic four months ago, and they are already treating 40 patients who came from across Asia.
Cho, 34, an immigrant who was a chaplain in the South Korean army, blends Zen Buddhism, Confucianism and psychotherapy in treating his patients, he said, tailoring the therapy to each patient's culture and needs. In his office, there is plenty of Korean green tea, used for meditation.
The treatment of culturally specific disorders may wind up being similar to the treatment of classic depression and other more general illnesses, with the use of psychotropic drugs or talk therapy or both. But for Asians it may mix different approaches: meditation and medication, Freud and Buddha. The main difference, cultural psychologists say, lies with the diagnosis: One person's depression is another's suppressed anger syndrome.
Cho's partner, Lan, a Chinese immigrant in her 40s, is a psychiatrist who also specializes in culture-bound syndromes. Lan said that her patients were accustomed to using herbs or to thinking of their problems as purely physical ones -- they often complain only of a backache or a stomachache and not of depression -- so it can take several sessions to persuade even severely depressed patients to try drugs. But both doctors said that more immigrants are becoming comfortable with the use of antidepressants and other medications.
The stigma and shame attached to mental illness, which can be much fiercer in Eastern cultures than in the West, can keep immigrants from seeking treatment, according to several experts and a 2001 report by the U.S. surgeon general. Many of the 800,000 Asian immigrants in New York City live in close-knit communities, where word spreads fast.
"Asians are often very reluctant to seek help," Cho said. "They may go to a pastor, a fortune teller or a friend's mother, but never talk to a shrink."
Ol Y., 46, a patient of Lan's and Cho's from Hong Kong, who spoke on the condition that only her first name and last initial be used, suffers from bipolar disorder. She waited years to seek treatment, filled with shame and with fear that the members of her church or her neighbors would find out something was wrong with her.
She was treated with drugs by a Western doctor, she said, but her "trembling" still would not go away. Her husband, who was laid off from his job as a software consultant for Wall Street companies soon after Sept. 11, 2001 -- only adding to Mrs. Y.'s stress -- said that he felt desperate to find her some help.
He began surfing the Internet and came upon information about the new program in Queens. Two months ago, Lan adjusted Mrs. Y's medications. Then Mrs. Y. began talk therapy with Cho, who draws on a mixture of approaches, including Mrs. Y.'s deep belief in Christianity, to treat her for the disorder.
Besides her bipolar disorder, Mrs. Y., who immigrated here 20 years ago, suffers from stress related to culture shock and often feels isolated, Cho said. In treating her, he has focused heavily on the way her mood, her anxiety and her fears have been affected by going to New York and her lack of support in the tiny network of immigrants she knows.
"I can stand on my own feet," Mrs. Y said. "I don't have to lie down all the time. I'm getting better and better."
Asian patients have physical differences that also make their treatment different from people of Western backgrounds.