Mental health in Mandarin Chinese: a starter kit for dialogue

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When my sister and I were growing up in Richmond, Va., my mother would make subtle comments about my sister’s body — noting how she was 胖 (pàng), which means fat in Chinese, or that her skin was too dark 黑 (hēi). My mother didn’t intend to bring harm. In fact, she always insisted that she told us the truth for our own good — 為了你好 (wèile nǐ hǎo) — or that we were too sensitive — 敏感 (mǐngǎn). I watched as my sister lost confidence.

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At school, we were taught to embrace body positivity and to speak up for ourselves. But at home, we could not find the right words in Mandarin to describe English words we had learned in school. We did not know how to say words like “depression,” “anxiety” or “fat-shaming” in Mandarin. The only Chinese vocabulary we knew was from what we heard in the house and saw on TV. Mental health was not a casual topic of conversation.

The intersection of mental health and language is personal. As bilingual second-generation immigrants trying to speak in our parents’ language, we were often sputtering and grasping at words to adequately express what we were going through.

Even bilingual therapists say translating English mental health terms into Mandarin is challenging.

The Times hosted listening sessions with Mandarin-speaking mental health professionals, academics, translators and community members. We asked them to list words that often led to cross-cultural misunderstandings. They also cited language they found useful to help open up dialogue. Some common themes popped up.

Illustration shows five shapes, each a different color, with two to four words inside of them. Each cloud contains words related to guilt, body image, gender and sexuality, depression and therapy and self-care.

胖

胖

壯

壮

為了你

为了你

fat

strong

for you

吃苦

吃苦

面子

面子

曬黑

晒黑

eating bitterness

saving face

tan

同志

同志

他/她/TA

他/她/TA

LGBTQ+

抑郁症

憂鬱症

he/she/they

depression

压力

壓力

遗憾

遺憾

pressure

心理治疗

心理治療

pity

psychotherapy

悲伤

悲傷

减压

減壓

自我關愛

自我关爱

grief

de-stress

self care

They told us that although there are official words for diagnoses in Mandarin, the terms often feel so clinical that many people don’t recognize them. Some emotional concepts, like being vulnerable, don’t have direct translations. Others carry harsher connotations in Mandarin. For example, while the word “boundaries” can allude to a healthy way to give someone space, if you translate it to 邊界 (biānjiè), it sounds like you’re referring to a border that is rigid and meant to keep people out. And terms vary among the many cultures and dialects across China, Hong Kong, Taiwan and other Chinese-speaking diasporas.

But the greatest barrier to conversations, especially in older generations, are the cultural stigmas, experts agreed.

It was not until I learned new words — such as 自卑 (zìbēi), which means “insecure”  — that I was able to narrow the communication gap with my parents. Instead of just saying, “I don’t like it when you say that,” I could articulate the effect their words had on me.

Experts also emphasized the importance of understanding why your parents might be saying these things. For my immigrant parents, not being “sensitive” was the only way to survive. Our worldviews and words to express them were shaped by the culture of the communities where we grew up. Finding the differences in vocabulary became a starting point for us to heal.

Inspired by stories about the nuances and power of language, we wanted to share a collection of words and phrases that have been helpful for others to talk about mental health in Mandarin. It’s important to note that talking about mental health can be delicate and triggering, and many people will never feel safe enough to broach these topics with loved ones. But we hope that these words spark conversations between you and your families.

Helen Li

Guilt

There are some Chinese cultural values that may paint the inability to cope as a sign of weakness, laziness or ineptitude. The guilt that comes with these cultural expectations can also keep people from recognizing or admitting they need help.

chīkǔ


eating bitterness

“Eating bitterness” is a Chinese term referring to the importance of persevering through life’s hardships. (chī dé kǔ zhōng kǔ fāng wéi rén shàng rén) is similar to the English proverb “no pain, no gain,” but it literally translates to “only those who suffer can become masters.”

It’s not a bad lesson because a good work ethic is worth striving for, said Jessie Li, a bilingual couples therapist and supervisor at Yellow Chair Collective.

But it can be used to invalidate a younger generation’s struggles; for example, 你不知道什麼是吃苦 (nǐ bù zhīdào shénme shì chīkǔ) — “You don’t know what hardship is.”

To Li, 吃苦 (chī kǔ) is about endurance, and when she’s talking to her clients, the question is whether enduring a particular situation is necessary. Is this stress part of what you need to overcome to find success, or are you in a situation where it’s better to move on from the suffering?

miànzi


saving face

In Chinese culture, the concept of saving face, 面子 (miànzi), is about maintaining your reputation, dignity and honor. But your personal reputation is inherently tied to your family’s reputation.

“There’s this idea that you keep issues, especially mental health issues, within your own family. If an outside person finds out about it, (hěn diūliǎn), — you’ll lose face, said Roy Ho, a graduate student in social work studying to become a therapist.

Lance Chen-Hayes, an author and LGBTQ+ advocate based in Taiwan, said 面子 (miànzi) is a concept he’ll often deconstruct with parents of queer children who are worried about stigma. “It’s about helping them prioritize what’s important,” he said. “And when they really think about it, saving face is on the bottom of the list. It’s not as important as they think it is. What’s more important is their queer childrens’ well-being.”

wèile nǐ


for you

“No matter the age of my clients, everyone talks about their relationship with their parents,” Li said. The values of filial piety and respecting elders are strongly ingrained in traditional Chinese culture. She said parents will often use the term 為了你 (wèile nǐ) to emphasize the sacrifices they’ve made “for you” or even “because of you.” Similarly, (wèi nǐ hǎo) — “for your own good” — is a way parents can otherwise justify harsh actions or criticism toward their children.

“If the parent says, ‘I came here to this country for you,’ and all they’re asking in return is good grades, it puts a lot of pressure on the children,” Li said.

Sharing your past sacrifices with your kids can lead to good conversation, she said. “But when it is used as a weapon, it is not healthy for the relationship, and usually there is no good conversation that comes out of that.”

The parents might have left their home country and started all over in another because they wanted a better life for their children, but it's unfair to put sole responsibility for the sacrifice on them, she added.

Body image

Comments on people’s bodies are thrown around extremely casually in Mandarin. Family members will greet each other with 你長胖了 (nǐ zhǎng pàngle) – “You’ve gained weight” – or 你變瘦了 (nǐ biàn shòule) – “You’ve gotten skinny” — as nonchalantly as they ask how a job is going. How do these cultural differences sometimes create misunderstandings about body image that affect mental health?

pàng


fat

Being called fat growing up is a common source of insecurity among her clients, Li said, and she thinks it’s helpful to remind people that Mandarin speakers might not have the same notion of body-shaming as Americans do.

For immigrants who may have grown up without enough to eat, gaining weight may be seen as a compliment. And when used among relatives and friends, it may be seen as playful, innocent teasing. But one way Li suggests explaining how hurtful these comments can be, in the context of American culture, is to say: (yòng wǒ de tǐzhòng lái gōngjī wǒ), which means “It seems like you’re using my weight to attack me.”

zhuàng


strong

The word 壯 (zhuàng) — strong — describes the body as muscular. It’s meant to be neutral, but for men, it could be seen as a compliment, and for women, it could be interpreted as a way to criticize them for not being thin enough.

Chao Zhao, a psychotherapist and art therapist at Yellow Chair Collective, understands what it’s like to go to her grandparents’ place and have them say “Look at your chubby face” with good intentions. But when she sees her daughter’s insecurity about her arms, she wants her to think of the term 壯 (zhuàng) in a positive way.

She’ll tell her 你不要瘦成桿一樣 (nǐ bùyào shòu chéng gān yīyàng). “You don’t want to be as skinny as a stick.”

“You have to be strong,” she’ll add. “That’s how to be healthy.” 你要壯。 這樣才健康. (Nǐ yào zhuàng. Zhèyàng cái jiànkāng).

shài hēi


tan

Another common way to comment on physical appearance in the Chinese community is to talk about skin tone. For example, it’s common to hear the phrase: 你曬黑了 (nǐ shài hēile), which means “You’re tan.”

Chinese skincare brands sell their products based upon the verb 美白 (měibái), to whiten. (Literally, the phrase is a combination of the words “beautiful” and “white.”) They also use the same term 美白 to refer to sun safety and prevention.

Zhao said that this type of colorism stems from outdated stereotypes about how lower-class outdoor workers tend to have darker skin, but she said these preferences and prejudices are still very prevalent in the community. “My clients who have fair skin will talk about tanning proudly, whereas my darker-skinned clients will tend to avoid getting darker,” she said.

There’s a collection of essays edited by Nikki Khanna and published in 2000 called “Whiter: Asian American Women on Skin Color and Colorism.” The clashing interpretations of skin color can lead to a lot of insecurity, confusion and resentment.

Gender and sexuality

In Mandarin, there’s one term that encompasses both gender and sexuality: (xìngbié). This can be confusing for English speakers who are used to talking about these ideas as separate concepts. Also, talking about sex, even between men and women, is taboo, so speaking about LGBTQ+ identities provides an extra challenge, as a lot of the newer Mandarin terms aren’t standardized — or even commonly used. So it’s extra important to come up with your own language to explain who you are, Zhao said.

tóngzhì


LGBTQ+

Chen-Hayes said that when he was translating the Family Acceptance Project, a resource to decrease mental health risks of LGBTQ+ youth, they thought a lot about the words they used to represent different identities. There isn’t a literal translation of LGBTQ+ in Mandarin, but many use 同志 (tóngzhì). This is a term started in Hong Kong in the ‘90s when people wanted to move away from 同性戀 (tóngxìngliàn), the more formal word for “gay,” which was associated with mental illness. It also didn’t include other queer identities, he said.

“同志 (tóngzhì) was used by the Communist Party to describe comrades,” Chen-Hayes said, “but the literal translation refers to people with the same goal or the same intention.”

“Language is such a living thing,” he added. “It evolves according to social movements, according to pop culture.”

tā


he/she/they/they

Gender pronouns in Mandarin bring about a unique conundrum, because while the words for he (他) and she (她) are written differently, they sound the same (tā).

The history of pronouns in Chinese is also complicated, Chen-Hayes explained. The term for he (他) started as a gender-neutral pronoun. The radical on the left of the character is 人 (rén) — person. The term for she (她) — which has the radical 女(nǚ) for female — was created for the women’s movement in the early 20th century. There also isn’t a natural equivalent for the singular “they” — 他們/ (tā men) — pronoun, because 們/ implies plurality. In more recent years, some have advocated using X也 (which use the English X as a gender-fluid radical) or TA (the pinyin Romanization of both pronouns), Chen-Hayes said.

While misgendering through pronouns doesn’t come up in conversation because the pronouns sound the same, it’s still an issue because in Chinese culture, it’s common to address everyone with salutations like 姊姊 (jiějiě) — big sister, 哥哥 (gēgē) — big brother, 女士 (nǚshì) — Ms., 先生 (xiānshēng) — Mister, 阿姨 (āyí) — aunt, and 叔叔 (shūshu) uncle. And all of them are gendered.

“What we’re trying to teach people is that instead of addressing a person, someone can ask, (qǐngwèn nǐ yào wǒ zěnme chēnghu nǐ)? ‘How do you prefer me to call you?’” Chen-Hayes said.

lǎodàbùxiǎo


not young anymore

In both Western and Chinese cultures, there are different expectations for women. Themes that emerged in the interviews and listening sessions included pressure for daughters to be proper, obedient and submissive, as well as to wear makeup, be in shape, take care of the family, be sympathetic to other family members’ emotions and contribute financially.

“The daughter is always being watched,” Zhao said. “‘Why can’t you do this?’ ‘What about this?’”

There’s also a term 老大不小 (lǎodàbùxiǎo), which literally refers to someone growing up, not being young anymore. While the words itself are neutral, it’s used more often for women, she said. One example is 你老大不小。 該考虑結婚了 (Nǐ lǎodàbùxiǎo. Gāi kǎolǜ jiéhūnle) — “You’re not young anymore. It’s time to think about marriage.”

Depression

In English, we often say phrases like “I am depressed” or “this is depressing.” But the Mandarin words for (yùmèn) — depressed — and (yōuyù zhèng) — depression — sound very clinical. How can we express these feelings of sorrow, grief and stress while preserving some of the nuances behind commonly-used Mandarin phrases?

yālì


pressure

Rayna Wang, a social worker who provides counseling to first-generation Chinese American children and their parents, explains that in the Chinese community, people often talk about mental health through physical symptoms. Worry or stress may be described as changes in energy or “qi” (氣), or 上火 (shàng huǒ), referring to changes in the balance of heat and cold inside the body, she said. People may also be more likely to seek treatment from traditional Chinese (or herbal) medicine to soothe these physical signs of stress.

“To me, ‘anxious’ and ‘depressed’ are foreign words,” Zhao said, and she’s seen many of her Asian clients shut down when talking about emotions. When people are feeling depressive symptoms, they’ll instead say, (wǒ zuìjìn kěnéng yālì tài dà), which translates to “I may have had too much pressure recently” or “I may have been too stressed recently,” she said.

When they attribute their struggles to high pressure, it’s easier for them to acknowledge the issue, she said. “壓力大 (yālì dà)” means the problem is outside of me, out of my control, and not my problem,” she said. “I think it’s part of the instinctual defense mechanism that will make people feel less overwhelmed and stay in the narrative of ‘I’m not sick, and I’m OK.’ Also, it’s the intention not to burden their loved ones.”

Sometimes talking about physical symptoms (headaches, stomach aches, insomnia) is a way of masking their experiences with stress, anxiety or depression, said JR Kuo — founder of CoffeeWithJR, which specializes in culturally-appropriate mental health and diversity/inclusion training. It can be a way to brush off any mental health challenges by saying, “It’s nothing, there’s just a lot of pressure at work.”

“Also, we know that people having severe mental health issues often feel physical pain too,” he said.

bēishāng


grief

When Wendy Guo tried to translate materials for the Los Angeles County Department of Mental Health into Chinese, she found it difficult to find the right words for “grief.” Guo, who now works at Mental Health Assn. for Chinese Communities, said she uses (shīqù qīnyǒu) to express losing family and friends. But in English, "grief" can be used to describe a loss of anything: relationships, jobs, pets or friendships.

Chen-Hayes adds that there may be words for grief in Mandarin — for example, 悲傷 (bēishāng) or (āishāng) — but there isn’t a direct translation for the verb “to grieve.” Grief is about sorrow, he said, “but the grieving process includes more than just sadness.”

Li recommends describing grief as as a process — (guòchéng) — and addressing each emotion (anger and denial, for example) as a series of separate emotions, because there isn’t one Mandarin term that encompasses everything that comes with grief.

yíhàn


pity

Because the Chinese term for “grief” is more commonly associated with the loss of a loved one, it’s harder to find the right word to talk about the need to grieve a lost opportunity, whether it’s the end of a job or the end of a relationship.

Li said the word 遺憾 (yíhàn) is a good way to talk about the feeling you get when you think, “It would be great if the person was still here” or “It would be great if I still had this job.”

There’s a lot of room for imagination, she said. It may be that something or someone leaves a strong memory, and you revisit that from time to time. It may make you nostalgic — (liúliàn). It can be beautiful. It’s not the quite the same as regret, which is (hòuhuǐ), she said.

“Regret is if you did something already and you regret it. 遺憾 (yíhàn) is you never got a chance to do it at all sometimes,” Li said.

Therapy and self-care

Explaining concepts like therapy or self-care can be challenging due to strong stigmas. People might not want to admit that their issue is that severe, or they might not want to spend the money. How do experts reframe this topic for anyone who might be resistant to treatment?

xīnlǐ zhìliáo


psychotherapy

The term for psychotherapy is 心理治療 (xīnlǐ zhìliáo), and the term for counseling is (fǔdǎo). But for clients who question why they need to see a therapist, Alison Hu likes to start the conversation by assuring that there’s nothing wrong with them. Hu, a bilingual therapist who was born in Taiwan and currently practices in the Bay Area, tells them, “Sometimes we need a little help.” (yǒu shíhòu wǒmen xūyào yīdiǎn bāngzhù).

Another term she sometimes uses is (zīxún), which means “consultation.” “A brief phone consultation provides an excellent opportunity for individuals to delve into the advantages and drawbacks of psychotherapy, ask questions, and learn more about the psychotherapy process,” she said. “When it comes to 輔導 (fǔdǎo) [counseling], there’s often the implicit belief that ‘something is wrong, and I need to fix it,’ whereas the term ‘consultation’ may not carry the same underlying assumption.”

zìwǒ guān’ài


self-care

A literal translation of self-care is 照顧自己 (zhàogù zìjǐ), which means to “take care of yourself.” But that is mostly associated with physical needs like eating, sleeping and showering, Ho said.

So when he talks about the importance of self-care for your mental health with his Mandarin-speaking clients, Ho likes to phrase it as a question. He’ll ask, “What do you like to do to relax?” (nǐ píngshí xǐhuān zuò shénme lái fàngsōng ne)? What do you like to do for fun? What are your hobbies?

He notes that he uses this strategy for English-speaking patients as well, if people assume that self-care is self-indulgent — or that you shouldn’t spend money on self-care. And sometimes physical self-care can be a good way to de-stress — 減壓 (jiǎn yā).

“Hygiene and eating is a boost not only to your physical health, but also your mental health,” Ho said. “A lot of times, one of the things that can help break stigma is breaking away from this model of having physical and mental health as separate, distinct things. … You can’t have one without the other.”

It's OK to not always have the words.

“The tension and conflict that we are observing and experiencing arise because some of the things we advocate in psychotherapy or mental health might seem, on the surface, to go against traditional Chinese values,” said Hu.

We’re supposed to embrace hardships, even if we suffer. We’re supposed to respect our elders, even if they criticize us. We’re not supposed to air our dirty laundry, even when silence is painful.

But as a therapist, Hu is passionate about serving this in-between generation, whose members can bridge the gap between cultures.

Wang said it’s also important to understand that the lack of Mandarin terminology and lack of understanding of certain concepts is not necessarily a weakness or a bad thing. It’s just that many of these English mental health words are Western concepts, and historically, Chinese culture thinks about mental health differently, she said.

That’s why Li thinks that when it comes to having mental health conversations with your friends and family members, the goal doesn’t have to be to find the perfect words every time. It’s more important — and meaningful — that you’re putting in the effort.

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