Diana Chao: A Mental Health Advocate Harnessing The Power of Collective Healing
Trigger warning: This article discusses mental health and suicide.
Diana Chao is reshaping public perception towards mental illness. The 22-year-old founded Letters to Strangers, an international youth-run organization reaching thousands of young people suffering from mental illness across the world through words of kindness from strangers. As a Chinese-American immigrant with bipolar disorder, she recognizes the harrowing effects of cultural stigmas on mental healthcare. Diana not only hopes to destigmatize mental illness worldwide but also works to combat inaccessibility to healthcare by advocating for personalized, affordable treatment.
“I ended up turning to writing,” she recalls.“And as I started writing these letters to strangers, I started to feel like I had a voice, and like I had a story that was worth telling.”
At age 13, Diana was diagnosed with bipolar disorder. “After surviving a series of suicide attempts, the last of which I was discovered by my younger brother, I got to a point where I realized I needed to heal, but I wasn’t sure how.” A variety of other factors, however, also contributed to Diana’s uncertainty regarding treatment. “A lot of the obstacles that stood in the way included things like the healthcare system, and being a first generation, low-income, below the poverty line, immigrant family. With parents who didn’t speak English, it was very difficult to try to navigate the healthcare system, especially given the cultural stigmas around mental illness.” As a part of a culture where mental illness is heavily stigmatized, and given her family’s financial circumstances, Diana realized that seeking professional treatment would be challenging. Without professional medical support, Diana turned to a unique coping mechanism that would ultimately become her passion: writing. “I ended up turning to writing,” she recalls.“And as I started writing these letters to strangers, I started to feel like I had a voice, and like I had a story that was worth telling.”
In 2013, feeling numbingly alone in her recovery journey, Diana began handwriting letters to children and young adults across the world, recognizing that others, like herself, could benefit from the kindness and support that a stranger’s words had to offer. She quickly realized that demonstrating empathy towards others helped her heal as well. “I was being kind and empathetic to people that I’d never even met, but I couldn’t do the same for myself,” she reflects. “So that’s when I really started to take that up as this motto that ‘Writing is humanity distilled into ink.’ That’s a key phrase that I really try to embody now.” The process of writing letters gives Diana a sense of control over her emotions and provides her with the ability to use her words to comfort both herself and others. “Our own heads might be our worst enemies,” Diana explains. “So when I’m writing a letter to a stranger, I’m forced to confront my thoughts and to try to make logic out of them—to infuse a sort of energy and aliveness into them because I know there’s someone on the other end reading it—rather than just succumbing to whatever overwhelming emotion I might be feeling in the moment.”
Letters to Strangers soon transformed from a stress-relieving hobby into a club at Diana’s high school. “I thought that if it could help me, it might help other people as well. I really just intended it to be a little pod of people coming together and really trying to be there for each other. But I guess a lot of people took a liking to the idea because then as people from nearby cities heard about our initiative, they asked if they could be chapters or start their own version, and that’s how the sort of chapter system was born.” Today, Letters to Strangers is the largest global by youth, for youth mental health nonprofit, impacting more than 35,000 people in over 20 countries with its network of writers and mental health advocates. Additionally, Letters to Strangers has created science-based peer education curriculums (including a published mental health guidebook), fundraised for various other nonprofit organizations, and led grassroots policy-based advocacy efforts, “which happens across local communities, on campuses, and also on state and federal legislative levels.”
Cultural divides in discussions about mental health are another prevalent issue that Diana seeks to tackle. “Over 86% of therapists in the US identify as white, and that’s a huge cultural barrier. Even without that, you also have language barriers and you run into issues where, for example, some languages might not necessarily have a word for depression or mental illness or whatever else.” When these factors, in combination with widespread stigmas surrounding mental illness, are present within a specific culture, an overarching desensitivity to mental illness is produced, one that hinders individuals from obtaining the help they need. Through their projects, Diana and her team at Letters to Strangers urge increased awareness of culture-bound syndrome, or the presence of certain behaviors and symptoms within specific cultures as a result of related psychosocial features. “To translate these concepts requires us to have a very acute understanding of, perhaps, similar symptoms in that culture that can be related to this, that make it easier to understand,” she says. In doing so, she hopes to ensure that underrepresented minority groups are heard.
An immigrant herself, Diana reflects on the cultural misconceptions of mental illness that she witnessed growing up. “I moved [to the United States] with my family when I was about nine, so there was a big cultural dissonance, of course. With any sort of immigration, there’s going to be that sort of adaptation required. But I think part of it was that we had to sort of just stay quiet and do things the right way, to not cause any trouble.” This cultural expectation inherently prevents open conversations about mental illness and frequently causes children, who are expected to remain obedient and to avoid causing trouble, to fear the expression of their symptoms. “It also was very awkward because America is a very individualistic and expressionist culture, and so I found a constant clash [with] the communal values in a lot of Asian and, honestly, just non-Western communities. It was a big clash.” Diana’s experience in America was eye-opening in that it allowed her to observe the stark difference in values between her culture and others. It also demonstrated to her that while mental illness would naturally be more accepted in a culture as expressive as that of America, it would continue to be heavily stigmatized in her own Chinese culture, in which speaking out is traditionally discouraged. Diana notes that even symptoms are treated differently between cultures. In some cultures, “There’s this idea that if you drink herbal tea or exercise more, then all these issues will just go away. That’s not how you solve a physical illness, and mental illness, in a lot of cases, is a physical illness.”
In response to increased discussions surrounding mental health in BIPOC communities, Diana remarks, “It’s good to have awareness, but a big part of the issue also comes down to the fact that there is just a lack of diverse providers. Even if you’re very well aware of the lack of resources, if we’re not actively putting in more money and personnel into those resources, it’s kind of a moot point.” Diana is working to tackle this issue via annual scholarships, sponsored by Letters to Strangers, that fund education for aspiring mental health professionals who come from and seek to further work with underrepresented minority groups.
“It’s good to have awareness, but a big part of the issue also comes down to the fact that there is just a lack of diverse providers. Even if you’re very well aware of the lack of resources, if we’re not actively putting in more money and personnel into those resources, it’s kind of a moot point.”
Beyond the inaccessibility of mental health resources, Diana pinpoints the issue that most people do not know what mental illnesses are actually composed of. Her general view is that people regularly misunderstand what mental illness actually is, and that they equate human emotions with disorder. “I think we should normalize seeking help as a preventative measure, rather than feeling that you have to justify it with a diagnosis. That’s what I want to normalize.” The existence of psychosomatic symptoms, or physical manifestations of psychological distress, is widely unknown in the medical field as well. Having experienced psychosomatic blindness, Diana explains, “This is something that can predominantly affect minority cultures, where the cultural stigma is so strong that, oftentimes, our bodies take the front of the damage for us to recognize that there is a problem.” By learning such responses to mental illness, people can better spot those in crisis, particularly within minority cultures in which the call for help is often a silent one.
Although Diana recognizes that, in a rapidly expanding digital age, social media is a valuable tool for encouraging dialogue about mental health, she wishes for more targeted, action-driven efforts that produce tangible results. “I think when we raise awareness, we oftentimes think of it like, ‘Let’s just throw [around] the hashtag #MentalHealth, #MentalIllness, #SelfCare, and then voila, I’ve done so much awareness’... and I’m like, I think we’re at a point now where people are aware of the terms! The problem is, how do you follow that up with proper education?” Her standpoint is that social media, or any sort of brief, chain-reaction form of awareness, can easily spark misinformation and does not represent truly targeted action that increases and improves mental wellness resources. “If you just have these sort of buzz words thrown around, but then [don’t actually follow up] with the education, the way that we respond to it is supplementing those words with imagery from the media, and maybe hearsay, etcetera, to try to better understand it. So, a lot of times, we get people who misunderstand things like depression as just being sad, or bipolar disorder as just being moody… because they see these depictions on social media or in movies, and the hashtags don’t come with that detailed education.” Instead, Diana recommends better ways to use social media as an advocacy platform: “It’s definitely important to have those reminders to take care of yourself or to take a break. At the same time, whenever we talk about mental illness, I think it’ll be good for us to always provide those resources that are well researched and credible to better understand the sort of nuances behind it. As much as we want to talk about this, we want to make sure we do it in a way that’s accurate.”
Despite the progress made by both her own organization, Letters to Strangers, and other groups working to alleviate the struggles of those affected by mental illness, Diana concedes that the system is far from ideal. Certain factors are missing from the healthcare system entirely, including an“understanding of minority cultures, psychosomatic symptoms, and culture-bound symptoms that predominantly occur within one culture.” Furthermore, there’s also a greater battle to increase mental healthcare worldwide, an issue that Diana persistently attempts to address through her own work. “Letters to Strangers has opened up two physical offices in Liberia and in Zimbabwe that serve as youth counseling centers, so these appointments partner with psychologists and psychiatrists, as well as some private clinics, to provide care for people. We also have a hotline. These are the first of its kind in those communities, and it’s something we’re very proud of and that took a lot of time to bring about.” Closing the gap between income disparity and accessibility to treatment remains one of Diana’s largest goals. To her, no individual or cultural group should be deprived of basic health and guidance resources. Lastly, she strives to make psychiatric treatment more humane. “In a lot of countries, and even still in some parts of the US, psychiatric care ends up just treating people as if they are no longer human... The more you strip someone of their humanity, the harder it is for them to feel like they have the dignity to fight back.” Her proposed solutions focus on addressing these core issues. “I think that’s the big thing: to emphasize more humane treatment, to bring in more psychiatric care and medication, but also to develop more research studies involving people of non-white populations to better understand how different types of therapeutic methods best benefit them.”
“I think that’s the big thing: to emphasize more humane treatment, to bring in more psychiatric care and medication, but also to develop more research studies involving people of non-white populations to better understand how different types of therapeutic methods best benefit them.”
Through Letters to Strangers, Diana has teamed up with L’Oréal Paris as a Woman of Worth Honoree and received the prestigious Unilever’s Young Entrepreneurs Award. She was, quite humbly, also honored to be named the “Fairy Godmother of Letters to Strangers” by one of the organization’s chapter leader. “I loved that,” she laughs. “I don’t want to be called the executive director anymore. I want [Fairy Godmother] to be my permanent title because that’s kind of how I see myself. What makes me really happy is that [the Letters to Strangers team] are the people who are on the ground and doing the work, and I want the spotlight to go to them. As much as I might receive awards and recognition that hopefully bring more recognition to Letters to Strangers and the amazing work that our team is doing, I consider this award something that’s not mine, but all of theirs. So me, being in that Fairy Godmother role, any glitter that I just have I just spread it to my Letters to Strangers fam!”
STORY ISHITA SHAH
PHOTOS LETTERS TO STRANGERS