This article is part of a series of articles commemorating Mental Health Awareness Month. We recognize that the stigma around mental health care — in Asian American communities, in particular — often keeps people from seeking help or having transparent conversations about the importance of mental health care. Mochi believes that caring for our mental health is an essential piece of caring for our overall health and well-being. We hope this series will shed light on how mental health care positively impacted these writers.
When my daughter Mia was 4, her preschool teacher expressed concerns about Mia’s behavior at school. While other kids drew pictures or played house, Mia stood next to a couch, silently observing children around her. Her face was blank, and she ignored her classmates’ invitations to play. She sat with her peers during circle time but rarely participated; on good days, Mia would nod or shake her head when the teacher asked her a question.
This observation didn’t surprise me. At home, she was active, expressive and playful. Yet in other social settings, she was a different child. She attended preschool twice a week and often woke up crying those mornings. Even at her young age, she kept track of the weekly calendar and anticipated the days she had school.
“She’s just really quiet” or “She’s shy — she’ll get over this” were the common responses from many teachers and other adults. But this was the first time anyone seemed worried about it.
I mentioned the teacher’s concern to a close friend. She told me about an anxiety disorder called selective mutism, a condition that keeps children from speaking or communicating in certain social settings, like at school. Yet in more comfortable, relaxed environments, like at home, these same children are capable of clearly communicating. My friend cautiously mentioned that how I described Mia’s behavior matched with what she knew about the condition.
I immediately Googled “selective mutism” and read all that I could find. I learned that the signs typically appear when kids are 3 or 4 years old, but often aren’t identified until the child is in a school setting where they are expected to speak and interact with others. I read about children with selective mutism being held back in school because their teachers were unable to evaluate their academic skills. Even worse, I read troubling accounts of children getting hurt and not being able to call out for help, or being abused because the perpetrators knew the children would endure the abuse quietly.
I was horrified by these extreme cases and felt overwhelmed reading through the stories, wondering what Mia’s future held. I felt a heavy sense of responsibility to make sure Mia would be safe, that she wouldn’t fall through the cracks. But I also felt relief. Relief that through a random conversation, I now had a name for Mia’s condition. And with a name, there could also be treatment.
I found a number of private treatment centers in the Seattle area, where we live, which would’ve set us back thousands of dollars. Then I discovered that Seattle Children’s Hospital, about 45 minutes from our home, offered the only hospital-based therapy program for selective mutism on the West Coast. Our insurance would help to cover therapy costs through the hospital, and whatever wasn’t covered would be subsidized with financial aid.
Fast forward six months: My husband, Mia, and I are sitting in a room with six other families, playing with building blocks. Another family and a roving behavioral therapist are within earshot, so Mia communicates with us through barely discernible nods. We meticulously word our questions in ways that coax her to respond. Despite there being so many people in a small room, the space is oddly quiet. After 10 minutes of playtime, the parents exit the room, leaving the children to play games with a therapist.
Over the eight-week therapy group, parents are expected to do the work too. We learn how to prompt our kids to respond verbally and nonverbally based on the phrasing of our questions. We also learn how our actions, such as ordering food or greeting others for our kids, enable them to continue avoiding situations that trigger their anxiety. Through the program, we are empowered to advocate for our children — whose behavior may be misinterpreted as shyness or rudeness — with relatives, friends and teachers.
Yet learning was the easy part; implementing it was a different story. We were expected to arrange opportunities for Mia to face her anxieties and practice her “brave talking.” One such opportunity was having her say her own name at the front desk when checking into therapy sessions, and it required us to stand firm when she refused and threw tantrums. It was excruciating for her (and us!). Other opportunities required enduring awkward pauses when people asked her questions and, rather than jumping in to save her, waiting silently for her to respond. And when she didn’t, I would simply say, “Mia’s working on her brave talking.”
Today, she speaks clearly, bravely and eagerly in most social settings. At school, she now answers questions without waiting to be called on. She is still reserved and quiet in new settings and around unfamiliar people, but she will speak up if and when she needs. However, while she has triumphed over selective mutism, anxiety continues to lurk beneath the surface. Nowadays, it shows up as anxiety over disrupted routines, unmet expectations, separation from family in new settings, and intense fears — of dogs, loud ocean waves, death.
I’ve heard repeatedly from others that she will outgrow these fears and her anxieties, even without therapy. I’ve heard others tell her that she doesn’t need to be scared when dogs run up to her or when she cries and demands to leave the ocean when the waves crash on the shore. While these responses are meant to be comforting and encouraging, I no longer see them as such. In her mind, she is scared and she does feel imminent danger, no matter what other people are telling her.
When we suppress the deeper mental health issues, we are only prolonging lasting healing and empowerment. If Mia hears from others that she will outgrow her anxiety and that her fears are unfounded, she may no longer feel safe to honestly express when she feels troubled and scared. She may continue to feel anxiety and believe she is innately flawed because of it.
How many of us have felt and expressed intense emotions — whether it’s fear, grief or anger — only to have others try to convince us that we are fine? That our emotions are not valid, despite experiencing a visceral response? Sadly, all too often, this is our instinctive response to children when they are trying to communicate their emotions. And this only teaches them that their emotions are not real, that they shouldn’t be feeling them, and that there is something wrong with having those emotions.
A close friend grew up being told by her parents not to cry or express her emotions; now, as an adult, she recognizes how her parents’ refusal to acknowledge and accept hard emotions in themselves and in their children has surfaced in the way she parents her children. Mental health was and is often neglected among Asian American families, like my friend’s, and especially among older generations. It is up to us to recognize this, to understand the importance of caring for our mental health, and to make that a regular practice for our own sake and the sake of future generations.
As I continue seeking help for Mia’s anxiety, it is crucial that I’m aware of how I discuss mental health care when speaking with Mia and others, particularly those who are not yet believers of it. I’ve asked Mia what I can or can’t say to others about her experience with selective mutism and anxiety, and I try my best to respect her wishes. I frame the challenges as temporary hurdles — ones that can be overcome with tools that empower us as parents and her as an individual. I also continually remind her of all her wins and how far she has come from day one.
Mia probably won’t be running away from dogs when she is in her 30s, but if it’s not dogs or waves, she will likely still face anxiety over something else. But at that point, my hope is that she will have had years of practice to work through her anxiety, no matter what the situation is. Seeking therapy doesn’t mean believing Mia is deficient in any way; it just means we are empowering her with tools to care for her well-being, now and in her future.
Photo credit: James Wheeler//Unsplash