Hundreds marched through Chinatown en route to the State House during a "Stop Asian Hate" rally in Boston on March 13. (Erin Clark/The Boston Globe via Getty Images)
Hundreds marched through Chinatown en route to the State House during a "Stop Asian Hate" rally in Boston on March 13. (Erin Clark/The Boston Globe via Getty Images)

'It Just Stays With You': The Corrosive Health Effects Of Decades Of Anti-Asian Violence

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Fear opens with the front door for Lisa Wong. It walks her down the street, and it follows her into the grocery store. Fear is a strange voice calling out from a passing car. It lurks around every corner. Fear is in her Zoom calls when she works as town manager of Winchester. That fear has a history. She recognizes it. When she looks at her own face, fear is a question written in yellow.

"Is somebody going to do something? Say something?" she wonders. "Because it does happen. It’s so common, and we see it in the news. These everyday actions become a potential setting for harm. That fear already exists, and it’s just heightened when things like this happen.”

Her fear sharpened after a white man shot and killed six Asian women and two other people inside Asian-owned spas in the Atlanta area on March 16. But it was with her long before that incident sparked a nationwide conversation about anti-Asian hate crimes.


Editor's Note: This story contains graphic descriptions of racism and racial slurs that may be upsetting. The story also contains language that some may find offensive.


All her life, Wong could pick up and move on from racist acts — both experienced and observed. But after a year of anti-Asian attacks across America, she can’t shake those feelings off anymore.

Instead, she thinks, “We’re not OK.”

Town Manager Lisa Wong at Winchester Town Hall. (Jesse Costa/WBUR)
Town Manager Lisa Wong at Winchester Town Hall. (Jesse Costa/WBUR)

It should come as no surprise that racial violence inflicts a burden far beyond the direct victims of an incident. There are the broken bones and lost lives, and the fact that this kind of violence targets more than one individual. It terrorizes people who share an identity, as activists pointed out in demonstrations against police killings of Black Americans. It also takes a toll on mental and physical health. And for Asian people, it's a burden that often goes unreported and under-studied.

Like many Asian Americans, Wong feels every attack on an Asian person. In that person, she sees her parents, her daughter and herself. But, she says, it seemed she and other Asian people were the only ones who did.

“Trying to articulate that and not being heard over and over again, especially when racist incidents happened to me,” Wong says. “That kind of stress, it definitely has a cumulative effect. And it does affect the way we are processing Atlanta.”


How Racism Hits The Body

At an Andover rally to stop anti-Asian violence a couple of days after the Atlanta shootings, Wong climbed onto a bench to speak to a few dozen fellow demonstrators. Mere moments before, a man in a black Dodge Ram pickup had slowed down and shouted through his cabin windows: “I love Asian women massages!”

There’s no megaphone, so Wong shouted to the group. At first unsteady, the words eventually poured out as if a dam had burst open.

"Did you see that man who said, 'I love Asian women massages?' " she shouted. "My mom can no longer tell me that things will be OK, and I can’t tell my 2-and-a-half-year-old that things will be OK."

When she got down, she noticed her body trembling, like every muscle was a ringing bell.

“I was just shaking uncontrollably," Wong says. "I was still shaking when I got into my car."

Jenny Wang, a clinical psychologist in Houston, listens to a recording of Wong's interview. As she absorbs Wong's account, Wang gives the steady nod of recognition. The experience that Wong is processing is a traumatic one, Wang says. And that trauma is as much a reaction to the pickup driver's veiled threat — in invoking the killing of six Asian women — as it is a response to the actual deaths of those women. Wang calls this vicarious traumatization.

“Even in observing someone else in a state of threat or distress, we actually have a physiologic response to that — sometimes because we can identify with that person,” Wang says. “There’s nothing we can do to address the violence. At the same time, the body has already been activated. Shaking is a way in which our body is trying to cope with the information, the input of threat.”

Demonstrators gather at a rally against racism toward Asians on Boston Common in March. (Courtesy Le Min)
Demonstrators gather at a rally against racism toward Asians on Boston Common in March. (Courtesy Le Min)

The body naturally reacts to perceived danger by pumping out a cascade of hormones including cortisol and adrenaline, priming itself to fight or flee, Wang explains. Research suggests that observing racialized and sexualized violence has a uniquely effective way of eliciting this response.

In 2017, researchers at California State University, Northridge, were studying how levels of the stress hormone cortisol changed in Latino students when they were exposed to racism. The students were brought into a room. Then, through a cracked door in the hallway, they heard either a scripted prejudiced conversation about Latinos or a normal conversation that was not related to race.

"I can't believe she keeps correcting the professor on how to pronounce her name," the person in the conversation would say, sighing. "Why doesn't she just pronounce it 'Patricia,' like a normal American?"

"Yeah, I hate it when Mexicans do that," the other person would reply.

Then, the researchers had the Latino students do a series of small puzzles, measuring their cortisol levels before the scripted conversation, during the puzzles and after. The cortisol levels of the students who heard the prejudiced conversation spiked twice as high as those who heard the conversation that wasn't related to race. And their cortisol levels also took longer to return to normal.

"Words that are not intentionally hurtful or directed at a specific person may still 'hurt' — affecting biological processes," the researchers wrote. "And potentially leading to long-term health consequences."

Other research suggests that Black people experience similar effects from racism, but white people simply don't appear to be as affected by racial violence or discrimination. In 2018, scholars at the University of Pennsylvania looked at how police killings influenced the mental health of Black and white Americans. They found that Black Americans suffered worse mental health for every killing of an unarmed Black person, but white people didn't experience worse mental health when they learned about killings of either Black or white people.

The full impact of racial violence on the health of communities of color likely extends far beyond what studies have so far captured, Wang says. Many analyses have been limited in scope or duration, often collecting data for only a few months, so they can't always be extrapolated to the length of a human life. But racism is a constant, going on day after day, long after the researcher's microscope has turned away.

“When we get stuck in that physiological [stress] state repeatedly over and over, that causes chronic stress conditions like cardiovascular disease or diabetes,” Wang says. “As Asian Americans, we add on another layer of stress. Now, we are fearful for our parents as they leave the homes. Now we’re worried that our children will be bullied.”

For many Asian Americans, a lack of recognition of the racism and racial violence we face may be an added source of harm, says Doris Chang, a clinical psychologist at the New York University Silver School of Social Work. Like other people of color, Chang says, Asians see themselves in the victims of race-related crimes.

“My son looked at a picture [of one of the victims in Atlanta], and he said, ‘that looks like Ā-pó,' which is my mother,” Chang says. “It was really, really hard not to personalize it as something that could have happened to anybody in my family.

"Are people actually going to see how traumatic and disturbing this is going to be for Asian Americans? That was the first question. And I really didn’t know.”


'So Much We Don't Know'

Compared to studies of African Americans and Latinos, the body of research focusing on Asian American health is conspicuously anemic. These studies often don't get funded, says Emily Zhang, a graduate student in psychology at Boston College who authored a paper on the health of Asian Americans in the pandemic. From 1992 to 2018, she says, only 0.17% of the National Institutes of Health’s budget went to studying Asian, native Hawaiian and Pacific Islander Americans.

“It’s deeply disturbing,” Chang, the NYU psychologist, says. “We tend to be more invisible, more marginalized in [race] conversations." As a result, "there’s so much we don’t know about the lived experiences of Asian Americans and the factors that predict health and well-being for this group.”

“It’s deeply disturbing. We tend to be more invisible, more marginalized in [race] conversations. ... There’s so much we don’t know about the lived experiences of Asian-Americans and the factors that predict health and well-being for this group.”

Doris Chang

Most research on the health effects of racial violence has focused on Black and white people. But racism affects each community of color differently, and a fundamental misunderstanding of Asian health may have led to misleading statistics concerning Asian mental health and well-being, Chang points out.

In mental health surveys from the Centers for Disease Control and Prevention, Asians report low levels of anxiety, depression and use of mental health care. That can create the perception that mental health isn’t a concern in the Asian community and doesn’t need to be studied.

But Chang recently surveyed roughly 700 Asian Americans across the U.S. over the last year about hate crimes and the experience of discrimination. She found that at least 40% of them reported one or more incidents of in-person racism including verbal harassment, physical assaults and property damage. That came with a related decrease in mental health.

“Those experiences were associated with heightened levels of psychological distress, including depression, symptoms of worry and anxiety,” she says.

The Stop AAPI Hate reporting center has recorded nearly 3,800 separate incidents of hate against Asians in the United States between March 19, 2020 and Feb. 28, 2021, a period that encompasses the ballooning of the country's coronavirus pandemic and some politicians' insistence on linking the virus to China, where it was first identified. That sounds like a big number but, next to Chang’s findings, it’s likely a staggeringly small window into the anti-Asian hate of the past year.

“[It] shows us how under-reported these events really are, how pervasive they are across our community, and that they’re happening to many, many more of us than are actually reporting it,” Chang says.

On top of that, understanding how racial violence affects Asian health is even more difficult due to some cultural barriers, Chang says. Seeking mental health treatment has historically been stigmatized in Asian cultures, so people may be reluctant to admit to experiencing symptoms of poor mental health — especially if they feel the questioner isn’t sympathetic to their cultural experience. Many Asians also simply don’t have the English language skills to communicate their experiences, or easy access to interpreters who can help them do so.

“We are outward representations of the success, or potentially the failures, of our parents, of our communities," says psychologist Jenny Wang. "So, there’s a lot of this idea of saving face that might make it difficult for people to express vulnerability, to ask for help, because these have traditionally been seen as signs of weakness."

But Wang thinks racism itself is likely one of the greatest culprits forcing the issue of Asian health into the shadows. To Wang, the stereotype that Asians are docile and reluctant to advocate for ourselves is the result of white supremacy acting on the Asian American community. That can have devastating health consequences.

“If you go to Asia, there are plenty of Asians who advocate for themselves just fine. The problem is that when we speak up [in America] and it’s silenced, we then internalize this message that my speaking up has no effect,” Wang says. “In the context of white toxicity and racism, that has put an inordinate amount of pressure on Asians living in diaspora communities to have to adapt and cope with the trauma of being in an environment that does not see them and does not protect them.”

Lily Chin holds a photograph of her son Vincent, 27, who was beaten to death on June 23, 1982, in a photo made Nov. 2, 1983. (Richard Sheinwald/AP)
Lily Chin holds a photograph of her son Vincent, 27, who was beaten to death on June 23, 1982, in a photo made Nov. 2, 1983. (Richard Sheinwald/AP)

Wang brings up Vincent Chin. In 1982, Ronald Ebens and Michael Nitz stalked Chin, a young groom-to-be, on a Detroit night. The two men searched for him, dragged him out of a McDonald's in view of two off-duty police officers and beat his head open with a baseball bat. He died at a hospital four days later.

The killing sparked a national Asian rights movement, but Ebens and Nitz, both white, never spent a day in jail. Charles Kaufman, the judge who first reviewed the case, claimed “these weren’t the kind of men you send to jail.”

Wang says the event showed Asian Americans that racism against us would be ignored. In order to cope, Wang believes many Asians numbed themselves to injustices and, under the threat of white supremacy, tried to diminish themselves to survive.

“All attempts to be heard, to fight for justice, have been stamped down,” Wang says. “It’s possible that we develop what is called learned helplessness. That’s associated with depression. I have seen this play out clinically in that a lot of my [Asian] clients really struggle with speaking up for themselves, expressing their emotions, being vulnerable.”

Seven years after Chin’s killing, a white man ranted about how Vietnamese immigrants were stealing American jobs and how he hated Asians. Then, he unloaded an AK-47 into 34 children and a teacher at the predominantly Asian Cleveland Elementary School in Stockton, California. The five children who died and most of the wounded were Asian. The shooting was never officially labeled a hate crime; its news buried in the second page of the Prescott Courier. It was 1989. This time, Asian people didn’t rally.


'It Just Stays And Stays With You'

Lisa Wong has had her own experiences of being ignored. Last July, Wong was leading a Zoom meeting for the town government of Winchester.

A recording of the meeting shows a man talking about stormwater management. Then he abruptly stopped; an intruder had hijacked the presentation. Racist hateful words appeared on the screen, then a barrage of disturbing images flashed across it, including men making a Nazi salute and holding shields emblazoned with swastikas.

A garbled, distorted voice began shrieking. It chanted, "White power. White power. Kill the n-----s. I hate them. Kill the chinks."

Then, the audio distortion dropped from the voice. Now, it was filled with glee, clear, high and reedy.

“Lisa Wong, you’re a chink,” the man said. He announced he'd placed a bomb threat to her address.

"Enjoy the bomb squad and SWAT team at your house," he said. "You can't hide your face, bitch."

When the voice and the images finally stopped, silence swamped the call. After a few seconds, Wong’s voice fluttered back.

“I think I’ve removed them,” she said and continued the meeting.

Wong struggles to talk about the experience. She won't — or can't right now — say the racial slur the man threw at her.

“There was something about my name and my face that gave him permission in his mind to say, ‘you are a ... , ' ” Wong swallows. “You know, that. The way he said it, it just stays and stays with you. I couldn’t consciously think of that event without breaking down. It stayed in my mind for about five months before I started to talk about it.”

But when she finally talked to other people who were on the call about what she’d heard, they shook their heads.

“I started hearing things like, ‘No, no, you weren’t the target. No, no, I didn’t hear that. That didn’t happen,' ” she says. “And that was very traumatizing. Then, to start to talk about it as part of my healing process and get denied was equally, if not more, traumatizing.”

"... To start to talk about it as part of my healing process and get denied was equally, if not more, traumatizing.”

Lisa Wong

In the days after the Atlanta mass shooting, that sense of being ignored hung over Wong like a shroud. For a year, many Asians felt like they were the only ones seeing members of their community be brutalized, beaten and killed for their race. Reeling from the Atlanta shootings, many Asian Americans went to work the next day wondering what senseless violence might happen next. When we blipped into virtual meetings or clocked into work, lightheaded like our breath had been stolen, we discovered the world had not, in fact, stopped.

“It was hard because people around them were acting like nothing had changed,” Wong says. “And for [Asian people], the entire world had changed. That resonated for me.”

The shooting, and the broader reactions to it, stirred Wong’s memories of the Zoom bombing. She watched an Atlanta police official say the department couldn’t determine if the shootings were racially motivated because the shooter said they weren’t. Wong says the morning after the shooting, she took the day off. She couldn’t work.

“I needed that time. The stress and the harm are happening at a faster rate than we can process,” Wong says. “As we’re processing what happened in Atlanta, we’re also processing everything else. It's all catching up to us.”


'It's Powerful To Be Seen'

In the days and weeks following the spa shootings, viral reports documenting attacks on Asians seemed to come quicker than ever before: a 65-year-old Asian woman stomped on the face in the noon sun in New York City; the cars of two Asian elders engulfed in flames in California; an Asian man getting a brutal scar carved across his face in Brooklyn.

"It’s pretty clear that being silent is not going to keep me safe. It’s not going to keep my daughter safe."

Lisa Wong

For many Asians, it was as if a hammer had struck something inside us. For generations, Asian Americans thought if we just worked harder than anybody else and stayed silent and unobtrusive, that would overcome anti-Asian racism in America. But under the weight of a year of racial violence, the deaths of six Asian women shattered the notion that Asians could pass through America unnoticed — but safe.

“Part of me like just wants to disappear, right?” Wong says. “Just like I think — we often do — if we just put our heads down and work hard, if you just don’t think of these things, then they will just go away. But that won’t happen. It’s pretty clear that being silent is not going to keep me safe. It’s not going to keep my daughter safe.”

Now, Wong and others are unlearning decades of silence. After the shooting, media attention on Asian issues skyrocketed, and Google searches for Asian hate spiked. Rallies to stop Asian hate have swelled to numbers in the thousands, and more Asians are speaking out about their own experiences of racism and the wave of violence that has targeted them over the past year.

For Wong, that has been a healing experience — especially when other women of color, Asian or not, stand beside her.

“It’s powerful to be seen,” she says.

Hundreds marched through Chinatown en route to the State House during a "Stop Asian Hate" rally in Boston on March 13. (Erin Clark/The Boston Globe via Getty Images)
Hundreds marched through Chinatown en route to the State House during a "Stop Asian Hate" rally in Boston on March 13. (Erin Clark/The Boston Globe via Getty Images)

But the change that needs to happen to protect her and her daughter in the future, is going to have to run deep. Institutions, laws and cultural attitudes need to evolve, says Gilbert Gee, a professor of community health at the University of California, Los Angeles.

“A lot of formal channels for reporting hate crimes, they’re not taking the reports seriously. A lot of the time, nothing comes out of the case,” Gee says. “There’s this presumption that it’s a bad apple, a bad apple having 'a bad day.' We should consider that maybe there’s rot throughout the entire system, and that means we need to change things structurally as well.”

That work can feel therapeutic, Gee says. But reforms also come slowly, and people like Wong are uncertain if the focus directed at Asians will last long enough for change to happen. In one hand, Wong holds the hope that it will. In the other, she says, is the fear that it won’t.

Related:

Angus Chen Twitter Reporter, CommonHealth
Angus Chen is a reporter for WBUR's CommonHealth.

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