Op-Ed: A Third Culture Kid in Pursuit of Clinical Psychology and Three Themes in Chinese Mental Health Research

by Natalie Hew-Yin Cheung

It’s no secret that the times in which we live are marred by misrepresentation of minority groups. As a digital media platform,  serving our community multiethnic, multicultural storytelling, All the Pretty Birds is partnering with House Of to celebrate Asian Pacific American Heritage Month. One of the most categorically false concepts to adopt with any racial group we call, the “monolith myth”. In the Asian community specifically, we lose the rich depth of cultures represented throughout the Eastern continent. Across our ATPB verticals, every Monday this month spotlights the abundance of creativity, inspiration, and cultural diversity of the Asian community. This Monday, All the Pretty Birds invites Natalie Hew-Yin Cheung to share her experience and global perspective on the crosshairs of mental health as a second or third generation Asian immigrant.



Op-Ed: A Third Culture Kid In Pursuit of Clinical Psychology


Growing up as a British-born Chinese woman, the idea of entering the profession of Psychology was something I had never considered until studying Psychology at secondary school. We didn’t openly discuss emotions or have conversations around mental health in my family. Although my parents were not particularly strict or demanding about my academic endeavors, I do recall conversations around whether I wanted to pursue a career in medicine or law. Perhaps having an older brother who had also studied Psychology helped my parents to see Psychology as a potentially rewarding and stable career. Luckily, they have always been very supportive of my ambition to become a Clinical Psychologist


(Pictured: Childhood photo of me, 1993 or 1994)


Similar to the experience of other people from Chinese diaspora, I struggled with my identity growing up and trying to make sense of what it means to be both British and Chinese. Whilst all adolescents typically struggle with making sense of their identity, being from an ethnic minority background can bring an extra layer of confusion. This is sometimes referred to as being from a ‘third culture’, or being a ‘third culture kid.’ This is essentially, “an individual who, having spent a significant part of the developmental years in a culture other than the parents’ culture, develops a sense of relationship to all of the cultures while not having full ownership in any…the sense of belonging is in relationship to others of similar experience.”* Throughout my adolescent years, I felt different to my peers, being British and Chinese, having a richness in two cultures, but never feeling fully part of either. 


My Journey to Clinical Psychology: Mental Health Accounting for Cultural Sensitivity


The route to training as a Clinical Psychologist in the UK is quite lengthy and usually includes a mixture of gaining clinical and academic skills. During my undergraduate degree, I was fortunate enough to complete a clinical placement with an excellent clinical supervisor who enabled me to publish a peer-reviewed article for the first time. From there, I gained clinical and research experience from different roles (Support Worker, Research Assistant, Assistant Psychologist) and completed a Clinical Forensic Psychology MSc, which included a clinical placement.


(Pictured: Me with some my Trainee Clinical Psychologist classmates, February 2019)


Currently, I am in my third and final year of Clinical Psychology doctoral training. As part of training, we complete a research project which aims to add to the evidence-base of mental health knowledge and understanding. In my doctoral application and interview, I spoke about wanting to contribute to an increased understanding of mental health that accounts for cultural sensitivity. Conducting my research study has been eye-opening and a project close to my heart. The full paper is expected to be published to a peer reviewed journal in due course, but the most compelling findings are outlined here.


The main aim of the research is to explore Hong Kong second-generation Chinese immigrants’** lived experiences of accessing mental health support in the UK and why this population may be underutilizing mental health services. Seven interviews were carried out, audio-recorded and transcribed. The transcripts were analyzed using a method suitable for exploring people’s experiences and tries to account for the researcher’s perspective (known as Interpretative Phenomenological Analysis).


During the analysis, patterns across participants’ experiences were identified, resulting in three main themes being identified:



Theme One: Representation of Mental Health in the Chinese Community


Interviewees’ parents were influenced by negative representations of mental health in Chinese media, usually Chinese television. Therefore, parents and family members from older generations were likely to have limited and negative views of mental health.  


Second-generation Chinese immigrants noticed differences to Western media portrayals of mental health, seeing more varied representations as a positive. However, they felt that first-generation Chinese immigrants saw Western media portrayals of mental health as depicting emotional weakness and a lack emotional control. Therefore, second-generation Chinese immigrants were typically less likely to discuss their mental health issues with parents and family due to the negative stereotypes held. Reluctance to share emotional difficulties went beyond the family and included potentially negative consequences within the wider Chinese community, such as being excluded from social activities. 


(Pictured: Extended Family Christmas Gathering, 2018)


Theme Two: Sharing Emotions in Chinese Culture


According to those interviewed, it was uncommon for Chinese families to share both positive (i.e. verbalizing pride or love) and negative emotions. Therefore, second-generation Chinese immigrants didn’t seek support from family for emotional difficulties. Interviewees discussed how perhaps emotions were expressed differently in Chinese culture and families compared to in Western families. For example, second-generation Chinese immigrants discussed how care and affection were expressed practically (i.e. by making food for a relative). 


There was an expectation for second-generation Chinese immigrants to suppress their emotions, even in emotionally difficult situations such as grieving a loss. Showing emotions was often considered to be a weakness or an inconvenience to others. On the occasions when second-generation Chinese immigrants did share their emotional difficulties, they were met with dismissal from family members, rather than receiving comfort or support. 


(Pictured: Me, dad and my brother, 1992)


Theme Three: Striving to Meet Chinese Norms 


The second-generation Chinese immigrants in this study used ‘striving for success’ to manage their mental health difficulties. They inherited their striving attitude from previous generations. Knowledge of how their parents and grandparents struggled made second-generation Chinese immigrants want to strive hard to make the most of opportunities that previous generations didn’t have, such as higher education.


Mental health difficulties were perceived as barriers to performing traditional Chinese roles within the family (i.e. duties as the only unmarried child in the family). Parental expectations for their children to strive for success contributed to second-generation Chinese immigrants putting the collective needs of their family over their individual needs. Achievements and failures of second-generation Chinese immigrants were openly discussed by parents and contributed to further pressure to strive. 


Even for second-generation Chinese immigrants who felt assimilated into the UK and under no direct parental pressure, pressure to succeed was still experienced in interactions with extended family. Comparisons made by parents, relatives or themselves was experienced by second-generation Chinese immigrants as stressful, anxiety-provoking and often led to burnout. Striving to succeed is likely to prevent second-generation Chinese immigrants from stopping and seeking mental health support due to unwanted discussions about mental health, associated feelings of shame, and loss of reputation or ‘face’. 



Final Thoughts


A lot of what was discussed by interviewees personally resonated with me, particularly how usual it is to not share emotions with family, and the drive to strive to succeed. This research isn’t without its limitations and does not aim to be generalizable to the wider Chinese population (unlike studies recruiting much larger samples), but these themes may be relatable to the wider AAPI community. I hope that these findings will help increase understanding of some of the unique cultural concepts that may impact Chinese people and their willingness to seek mental health support – something the greater community of AAPI allies should also be aware of.


[* Fail, H. (1996). Whatever becomes of international school students?. The International Schools Journal15(2), 31.]

[**In this study, second-generation Chinese immigrants are individuals of Chinese ethnic origin but were either born in Britain or had left Hong Kong before the age of 10.]


Editor’s Note: 

Our team at All the Pretty Birds is incredibly grateful to Natalie Hew-Yin Cheung for sharing her personal story and a sneak peek into the findings that are setting her apart in the Clinical Psychology field. As a community of many first, second, and third generation immigrants we are further thrilled to forward the nuanced conversations around cultural influences and mental health. We hope you found this research as insightful as our team did. Until next time, Pretty Birds!


All images are courtesy of Natalie Hew-Yin Cheung.


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