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In 2015, a cluster of suicides among high school students in Palo Alto made national news because it was tragic, it echoed a similar suicide cluster from 2009-2010, and it raised questions about adolescent mental health in an affluent community.   Most news reports did not mention that four out of four of the completed suicides in 2015 were Asian American, at a time when the Palo Alto school district was approximately 40% Asian.  As the psychiatry department at Stanford responded with a series of interventions for the teenagers, we also wanted to reach their parents, whose upbringing may have made mental health issues taboo.  When we convened a panel of local mental health professionals in 2015, Asian parents listened intently to information about cultural issues and differences in communication between generations, but asked as well for more practical interventions.  We immediately began writing and planning a series of innovative theatrical "vignettes" that would have more immediacy and emotional impact than our previous lectures, and in the spring of 2016 we started performing them in local high schools and middle schools in Palo Alto and Millbrae. 

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I drew in part on my academic background, having trained at University of California, San Francisco for medical school, internship and residency, specifically on the Asian Focus Unit and the Black Focus Unit at San Francisco General Hospital, awarded the American Psychiatric Association's Minority Fellowship, joined the Minority National Mentors Network, and lectured nationally on cultural psychiatry.  (Nationally, Asian-American youth are at higher risk of suicide than their non-Asian peers, and they cite family expectations and differences in acculturation as a top stressor.)  I drew on my experience in clinical psychiatry, having treated thousands of patients from diverse backgrounds in both the inpatient hospital and outpatient clinic settings.  But most of all, I drew on my experience as the daughter of Chinese immigrants, and the mother of a teenager; I experienced first-hand the problems that can arise when communication styles from one place are transplanted to another.  Stanford faculty members, psychiatry residents, fellows and students with diverse backgrounds wrote scripts, practiced, and became actors, bringing to life common scenarios such as arguing about grades and video games, bringing home an "unsuitable" boy or girl, and being embarrassed by a parent's accent.  Each scenario was performed first one way, the actors paused and took questions in character, and then they performed the scenario again, this time using the suggestions from the audience and moderator.

 

The response has been electrifying: local and national coverage including front page news, television and radio, and invitations to perform the vignettes nationally and internationally.  But even more gratifying is the response from audience members: parents who realize that they are not alone in their struggles, who talk openly about their assumptions and fears, who challenge the shame and stigma associated with mental health issues.  They laugh, they cry, they share stories, and they pledge to listen more and widen their perspectives.  We plan to expand the vignettes in response to requests: to write a series for the teenagers themselves, to expand the cultural focus (for example, to South Asians next), to invite the parents to role-play the scenarios themselves, and to make the vignettes more available through social media (available in "our vignettes" page via YouTube) and professional video productions, as well as live performances.  As doctors we have found a rare "treatment" that has no unpleasant side effects, that keeps working long after it's prescribed, and that we hope can save lives.