Finding laughter after tragedy

By Stacy Nguyen
Northwest Asian Weekly

Anna Akana with President/CEO of Didi Hirsch Mental Health Services, Dr. Kita S. Curry (Photo by Didi Hirsch Mental Health Services)

“We had a really good relationship,” filmmaker, actor, and comedian Anna Akana, 27, said, describing her sister Kristina. “Like any relationship with any sisters three years apart, we fought a lot over her borrowing my clothes, her tagging along. We had a good relationship for the most part. She was the one who actually wanted to get into entertainment. She would do talent shows and was really outspoken and creative, which I really admired.”

“So when she killed herself in 2007, when she was 13, it was devastating to our entire family. None of us saw it coming. For two years, I kind of wanted to figure out whether I would go the college route or the military route. I had always assumed that I’d go into the military to follow in my dad’s footsteps. After she died, all of it felt pointless.”

Akana was 17 when her sister committed suicide.

Suicide rates in teens

In the 1980s and 1990s, the U.S. suicide rate was actually on a downward trend, attributed to advances in medicine. A new class of antidepressants, selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), were coming out, ones with fewer adverse side effects than their predecessors.

Prior to the 1980s, a class of drugs called tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) were used to treat depression.

Today, the majority of drugs prescribed to treat depression are SSRIs. They are better tolerated and safer than TCAs and MAOIs.

Yet, the downward trend of suicide rates — across all age groups — experienced an abrupt stop around 1999 — and then began increasing. Among young girls, in particular, the statistics are stark. A Centers for Disease Control and Prevention (CDC) study (“Increase in Suicide in the United States, 1999-2004”) found that girls between the ages of 10 and 14 experienced the greatest jump in suicide rate, tripling from 0.5 to 1.7 per 100,000 people.

Experts attribute the increase partly to economic stagnation, which resulted in many people lacking access to health care — thus, lack of access to antidepressant medications.

Also according to the CDC, suicide is the second leading cause of death of those ages 10 to 24. More teens and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined.

Anna Akana with veteran actor George Segal (Photo by Didi Hirsch Mental Health Services)

The beginning

Akana grew up in a military family. Her father is Japanese and Hawaiian. Her mother is Filipina and white.

Due to her dad’s career in the U.S. Marine Corps, the family moved every two to three years.

Akana describes her family as having so much laughter when her sister was alive. However, after Kristina’s death, Akana internally shut down and had a hard time finding any humor or happiness in life.

It wasn’t until she watched Margaret Cho’s stand up that she laughed again. “[It was] the first time in the two years since my sister’s death.”

Thereafter, Akana started up her very popular YouTube channel, with more than 1.8 million subscribers. Her channel features a comedy-forward style that presents relatable topics to young people — Akana not only talks about her sister’s suicide and her own struggles with depression, but she also talks about race, dealing with bullies, and lighter topics such as how to apply makeup. Her popularity on YouTube has been parlayed into other media. Akana has directed and produced a web series and is slated to appear on “Stitchers,” a TV show for young adults on the Freeform network.

It is perhaps her advocacy work in suicide prevention that makes her resonate so strongly with her young fans.

“Asian Americans are the highest group prone to depression of any race, but the least likely to get mental health help,” said Akana. “Asian women are in the second highest group to commit suicide. Suicide is the second leading cause of death in teens. I feel like all those stats are [reflective of] the experiences in my life. … I think being open and having a conversation about that kind of stuff [is important], providing people with resources. I talk about my clinical depression … I’m also open about how I’ve been in therapy for years. Being open and candid about what is going on [helps eliminate stigmas about mental health].”

Early puberty

Studies have linked early puberty with depression in teen girls. According to the May 2016 study, “Age at Onset of Puberty and Adolescent Depression: ‘Children of 1997’ Birth Cohort,” researchers looked at the heath records of a group of 8,327 children born in Hong Kong April-May 1997.

Researchers found that girls who had earlier breast development (compared to their peers) had a higher risk of depression symptoms or an increase of depressive symptoms. The researchers did not see the same correlation in boys, and these results also took into account factors such as socioeconomic status, weight, or parents’ marital status — that is, this is an issue that crosses cultural backgrounds.

In the early 20th century, an American girl got her first period around age 16 to 17. Today, according to the National Health and Nutrition Examination Survey, the age has decreased to 13 and under. This trend downward is being studied and may be attributed to many things, such as overweight children, greater exposure to environmental contaminants — such as the plastic compound phthalate.

Early breast development is controlled by estrogen, but past research has eliminated estrogen as a driver of depression. Researchers have stated that more studies need to be done on this, though there is educated speculation that the social and cultural context of puberty — not just its biological — may inform the correlation between the rise of depression in girls who go through puberty early.

Jane Mendle, a clinical psychologist at Cornell University, told the New York Times that the onset of puberty changes the way adults and peers treat these young girls. Often, girls are bullied when they physically mature earlier than peers. Additionally, handling the physical and hormonal changes of puberty at an earlier age also means that these girls are not as cognitively and emotionally developed to work through the challenges that are usually reserved for girls a few years older — or more.

A 2015 Newsweek story, “Puberty comes earlier and earlier for girls,” pointed out that early maturing girls attract unwanted sexual attention from older boys and also adult men. The age in which girls have to learn to “cope” (for lack of a better term) with these responses from boys and men is decreasing more and more.

Other studies (“Pubertal timing and vulnerabilities to depression in early adolescence: differential pathways to depressive symptoms by sex”) find that along with higher rates of depression, girls who start puberty earlier are also more prone to obesity and drug abuse. These girls are also more likely to smoke cigarettes and have eating disorders — all issues that permeate their later adult lives.

The issue of stigma

“I don’t think there is one overarching trait for people who commit suicide. I think the generalization that the only people who commit suicide [show signs of] always being depressed. Sometimes there are people who [commit suicide and appear] completely fine.”

“My sister was a little manic depressive,” adds Akana. “She was gregarious and great a lot of times, but she was also a 13-year-old girl going through stuff. … I don’t know if [her suicide] was a brash decision … or if it was a sign of mental illness. Suicide is the second highest cause of death for kids 12 to 17. It’s confusing [to be that age].”

Akana explained that she thinks the context around teen suicide is a little different than adult suicides. As teens are still developing in many ways, they tend to behave in a much more impulsive way.

Studies have also shown that most teens (certain studies put the number at 90 percent) who commit suicide had some form of mental health issue.

According to the CDC, about 20 percent of Americans experience a mental health disorder in a given year. Of that group, only a quarter of them feel that others are understanding or compassionate about their illness. This dissonance is stigma.

People with mental illness are more likely to encounter police and law enforcement than medical health professionals. They are also more likely to be blamed for violence even though the reverse is true — they are more likely to be the victims of violence. They have high rates of homelessness.

And yet, there is the persisting, pervasive belief that those with mental illnesses are merely weak and need to mentally move past their illness.

According to the CDC, Asian Americans report fewer mental illnesses than whites — however this could be due to stigma. More young Asian Americans in their teens, for instance, report considering suicide compared to their white counterparts (18.9 percent to 15.5 percent). Asian American females are also twice as likely to attempt suicide (15 percent) compared to their male counterparts (7 percent).

Barriers to mental health care for Asian Americans include language barriers, but also lack of awareness of resources and services. Attributed to Asian culture, which places a taboo on discussing mental health, Asian Americans also tend to ignore, deny, and neglect symptoms of mental health illness.

Akana said that even after her sister’s death, her parents’ response to Akana’s own clinical depression was ‘typically Asian.’

“When I told my parents I had depression, they gave me a bag of niacin,” she said. “They are old-school.”

Recognition

For her advocacy work around suicide prevention and reducing stigma surrounding mental health illnesses, Akana was honored with the Mental Health Ambassador Award at the 2017 Erasing the Stigma Leadership Awards on April 27. The event was organized by Didi Hirsch Mental Health Services, a leading Los Angeles-based nonprofit provider of free community mental health and substance use services for children and adults for over 75 years.

“It’s an honor [to get the award],” said Akana, before the awards ceremony took place. “And I’m super excited to get to talk to everyone. It’s nice to be in a group where we’ve all experienced the same thing and get where each other is coming from.”

For more information about Anna Akana and her current projects, visit annaakana.com. For more information about Didi Hirsch Mental Health Services, visit didihirsch.org. The National Suicide Prevention Lifeline number is 800-273-8255. The Crisis Text Line can be reached via texting “Home” to 741741. To reach Seattle-based, API-based help for mental health issues, visit or contact Asian Counseling and Referral Service (ACRS) at acrs.org.

Stacy Nguyen can be reached at stacy@nwasianweekly.com.