Depression in the Elderly Population of the Vietnamese Community in Orange County, California Part 1/3

Editor’s Note: This work was written by Huyen Duc Duong and originally edited by Duong Nhu Nguyen and Nhu Duc Dzuong. For readability, the study has been edited for style and will be published as a three-part series. For the purpose of furthering academic inquiry, the US-Vietnam Review will publish works such as the following, however, please be advised that the Review does not endorse all contextual interpretation herein. 

Duong Nhu Nguyen

PART I:  IDENTIFYING THE PROBLEM

Introduction

Depression is a chronic disorder, characterized by persistent feelings of sadness, helplessness, hopelessness, and irritability. Depression seems to be more prevalent today than  decades ago, despite technological advances and the availability of cyberspace societies that  connect people around the world.  Depression affects people of all ages and all socioeconomic levels, regardless of sex, race, and culture. Depression is widespread and very common in industrialized countries such as the United States and Japan. Obviously, depression is a problem for the sufferer, but it can also present difficulty for those who are associated with the depressed individual. The intensity of depression can vary from mild to extremely severe, leading to serious health problems including suicide. Recognizing depressive symptoms in older people is often missed because many mistakenly hold the view that it is normal for the elderlies to feel depressed.

The Vietnamese community is a rapidly growing minority in the United States, especially in Orange County, California — Vietnamese constitute the fourth largest ethnic group in the Asian and Pacific Islander category in the demographics of America.  As of 2000, the number of Vietnamese in the United States was estimated to be around 800,000, an increase of 53 percent since the late 1980’s (U.S. Bureau of the Census, 2000). Vietnamese elderlies are often a quiet sub-group of individuals who do not catch the attention of the American mainstream or the academic community. This serious data deficiency and neglect should cause concerns to gerontologists and families. Hence, it is pertinent to uncover possible causes, signs, and symptoms in order to recognize and identify depression, with the goal to develop treatment plans suitable for the Vietnamese elderly population.

A.  Description of the Problem

The Vietnamese population is a rapidly growing minority group in the United States, especially in Orange County, California. Vietnamese elderlies suffered from mental health issues during their refugee experience: they typically underwent sudden and involuntary transplantation to a foreign culture, after many years spent in squalid refugee camps or being held in political detainee prisons in Vietnam for a decade or more. They faced language barrier and drastic change in living environment, while still harboring unforgettable, horrific life events of the past. Vietnamese elderlies thus sustained heavy challenges and numerous latent stressors that lead to severe depression in the later phase of their life.

B.  Purpose of Study

The purpose of this study is to help develop a program that recognizes the presence of depression in this population, and to help Vietnamese elderlies understand this serious medical condition, which can lead to suicidal thoughts or other destructive behaviors. The program focuses on the intervention of depression in the elderlies of the Vietnamese community in Orange County, California, i.e., how to deal with the problem as it occurs in daily life, in order to be of help to the individuals, social workers, and their families. Such program offers up-to-date information on what depression is, identifies the causes of depression, and proposes treatment.

The more that is known about depression in Vietnamese elderlies, the stronger the knowledge base will be for medical professionals and social scientists, as well as families. Hopefully, such knowledge base may enable the studied population to live a healthy and fulfilling life. Improving recognition and treatment of depression in late life will make those years more enjoyable and meaningful for the depressed person, his or her family, and caretakers.  This study can also be used to discover the prevalence of depression in other minority groups such as Mexicans and African Americans, as well as mainstream Americans, and can also provide the basis for suicide intervention among elderly ethnic groups in the United States.

C.   Objectives

The envisioned program serves the following objectives:

1. Enable understanding of the signs and symptoms of depression by using the depression
2. Enable understanding of the causal factors as well as the treatment of depression for drawing an effective
3. Explore the prevalence of depression in Vietnamese American immigrant elderly
4. Implement ways of coping with depression to improve life

D.   Historical Background

Vietnam has 4,000 years of history filled with tales of battlefields. The Chinese conquered Vietnam in 111 B.C and ruled Vietnam for the next 1000 years, instilling in the native population Confucian philosophy and political culture. In 1858, Vietnam fell prey to another foreign invader, France.  The French began their conquest of southern Vietnam and, by 1885, occupied all of Vietnam. France governed Vietnam for almost 100 years. The defeat of the French at Dien Bien Phu in May 1954 ended the eight-year war and led to Geneva peace talks. The Geneva agreement divided Vietnam into two zones: Communist and non-Communist, at the 17th parallel.  Northern Vietnam was ruled by Vietnamese communists, and the South belonged to the Republic of Vietnam.  The war between North and South ensued, with the U.S.’s military involvement and American aid given to the South, while the North was supported by the Communist Bloc. The U.S. officially withdrew its troops from the South in 1972, according to the Paris Peace Treaty.  On April 30, 1975, Vietnamese communists finally took over Saigon, capital of the South, ended the war and unified the country.

After the fall of Saigon, many Vietnamese escaped Vietnamese communism and resettled in other countries around the world. By 2000, as per U.S. census, approximately 800,000 Vietnamese refugees had successfully immigrated to the U.S. while many died at sea during their escape (A number of them were repatriated back to Vietnam from Hong-Kong). Most Vietnamese refugees settled in Southern California, particularly in Los Angeles and Orange County, because of the familiar mild climate and community support from the earliest wave of Vietnamese refugees who were processed in Camp Pendleton, California. Others settled in other states, with larger concentration in Texas and Virginia (data published by Southeast Asia Resource Action Center, 2002).

1. Vietnamese Migration

The communist victory over the Republic of [South] Vietnam resulted in mass migration of Vietnamese to other countries in the Western hemisphere and around in the world, as refugees risked their lives to escape communist Vietnam in order to seek freedom. Generally speaking, there were three “waves” of Vietnamese refugees:

1. Those Vietnamese people who worked with the S government or who sympathized with the South feared for their lives once President Nguyen Van Thieu lost power. In 1975, approximately 130,000 Vietnamese fled to the U.S after the collapse of Thieu’s regime. This first wave of refugees escaped with the help of the U.S., and generally were relatively young, well-educated, English-speaking urban dwellers. Most were kept at relocation centers on U.S military bases until sponsors were found to help them resettle.
2. The second wave of refugees who left after 1978 was a more diverse group, frequently classified as “boat people” because they escaped Vietnamese in small, make-shift These refugees who escaped later included ethnic Chinese. This second wave was generally less educated, less exposed to the West, and came from rural backgrounds (Kelly, 1998). During the second wave, escape attempts were long and arduous; only approximately half of those attempting escape survived, because hoards of people attempted to escape by crowding tiny and unseaworthy boats. The population included both older Vietnamese and young children. Travel by boat was filled with peril; many died due to diseases, mishaps on overcrowded boats, or at the hands of brutal pirates who robbed, raped, and killed. Those who survived spent years in internment camps in Thailand, Indonesia, and the Philippines prior to entering the U.S. or other third countries, primarily through processing by the UNHCR (United Nations High Commissioner for Refugees).  Many suffered from malnutrition, diseases, and horrible treatment at the hands of pirates and camp guards. The escape routes included both by sea, as described above, or by foot through jungles to neighboring countries such as Thailand.  Whether by boat or by foot, many were caught by Vietnamese  Communists  and sent to prison. Yet, many escaped again and again, until they could reach the land of freedom or simply died en route.  The exact number of those who lost their lives on the escape route could not be verified, but was believed to reach millions.  The situation became a global crisis for Southern Asian countries that had to house the refugees while waiting for UNHCR processing, and for third countries who admitted them on refugee status.

Rural people in the second wave are less likely to speak languages other than Vietnamese. Some have difficulties learning to read and write a second language because they were farmers or fishermen; many were not literate even in their native Vietnamese. If they had learned to read and write, they seldom used these skills (see http://ethomed.org/ethomed/cultures/Vietnamese/Vietnamese cp.html).

1. The third wave of refugees left Vietnam between 1985 and 1991, and continued to arrive in smaller groups. They were brought to the S through family reunification programs (called ODP, Orderly Departure Program), in accordance with U.S. immigration law. Or, they travelled to the U.S. or other third countries as part of overseas visits and decided to stay on to seek asylum. Additionally, in 1988 and 1989, the U.S government negotiated the release of South Vietnamese political detainees held in “re-education” camps under the Communist regime (called the “HO” (Humanitarian Operation) program). Many people in this wave had spent years in labor concentration camps under devastating conditions and, hence, most likely suffered from long-term post- traumatic stress disorder (“PTSD”).
2. The Vietnamese Culture

Throughout many centuries, although the Vietnamese culture has been reshaped by foreign invaders, one can recognize and articulate the distinctive values or essence of the Vietnamese culture. Vietnamese came to the U.S from a culture vastly different from mainstream America. The Vietnamese culture basically rests on principles of Confucianism at its best. Contrary to the West’s individualism, the Vietnamese culture emphasizes the importance of family and community. Its core values are harmony, honor, respect, and allegiance to the family. At home, one is expected to show respect to parents and senior family members. Outside the home, respect is shown to elderly people, teachers, and other authority figures. Vietnamese are taught as children to forsake the ego and make individual sacrifices to ensure the family’s welfare and harmony. Allegiance to one’s family is absolute and includes fulfilling one’s responsibilities, obligations, familial role, duties and proper conduct. Family is the cornerstone of Vietnamese society. As opposed to the American immediate nuclear family, Vietnamese follow the extended multi-generational family system. The father is the central figure and is responsible for the well-being of every member of his family. Children are responsible for the maintenance of the ancestral tombs and pay homage to ancestors’ spirits at home.

Beyond the extended family, familial obligations also involve the physical setting and surroundings in which the family resides, meaning the native village. The attachment and obligations to the native village stem from the concept of harmony. The parent-child relationship is deeply attached to the identity of the self. Children are taught to behave according to the principle of filial piety. The child who lacks filial piety is rejected and ostracized by other members of the family and community. A typical Vietnamese is not an individualist. Each individual strives to be the pride of his family. Members of the extended family are bound together by a sense of collective and mutual obligation. For example, children have duties to obey their parents and not to challenge or resist their authority and teaching. (This also means that parents and grandparents should also try to be good and set exampls for offsprings.) As far as the legitimacy and moral bases for such authority and teachin by elders, Vietnamese are indoctrinated in the four steps of Confucian values:  tu than, te gia, tri quoc, binh thien ha (first to work on perfecting the self; second, to establish harmony and order for the family; third: to help develop and manage nationhood, and fourth: to achieve peace and balance for humanity).

Among the not-too-good aspects of neo-Confucianism impressed upon the Vietnamese culture was the treatment and status of Vietnamese women after cumulatively more than one thousand years of Chinese rule (from the Han to the Manchu (Qing) Dynasty).  Historically, Vietnamese women were expected to marry early, bear children, and serve their husbands; their education and employment were strictly limited (Ricky, 1964). Marriages were arranged by parents or grandparents. Divorce was not a common practice. The wife was usually dominated by her husband, her father-in-law, and sometimes, her adult son.

As Western influence increased in Vietnam during the 20^th century, parents began to take more of an advisory (rather than determinative) role in the choice of their son’s or daughter’s mate, and arranged marriages were starting to decline. As a result of the forces of modernization, urbanization, and industrialization, the strict role of the Vietnamese wife had been relaxed and expanded.  (It should be noted that the Vietnamese indigenous society prior to Chinese rule was basically matriarchal, and celebrated female warriors as well female nation-builders.)  In South Vietnam, prior to the Communist takeover of Saigon, South Vietnamese women in big cities were akready able to get good jobs or attended universities. Nonetheless, the activities of young women outside the home were much more restricted and often supervised by their fathers or husbands. Due to the effect of migration and Western influence, traditional gender roles have changed or are changing. Vietnamese women have gradually occupied both homemaker role as well as the provider role in order to support the family in America.

3. Difficulties in A New Home

Refugee families in America have had to deal with many issues in adapting to their new home. In patriarchal Vietnam, traditionally male elders were the leaders in their families, had the strongest authority or influence in decision making, and were respected and sought after for advice. Also, elders held property rights of the family, and retired only after their children could support the family. The retired male elderly still remained head of the household in terms of commanding the hierarchy and respect. When the elderly died, control, authority, and responsibilities were passed on to the oldest son.  However, behind every male elderly was the female matriarch, who provided emotional support and nurturing for the family structure – literally the female matriarch behind her man typically controlled the family budget and maintained the “micro-economy” for the family.

When these elders were transported to the US, especially as part of the second and third waves of refugees, they lost their property and much, if not all, of their material goods or even their ability to earn a living. In America, many elders who want to work outside the home are unable to, because of their lack of training for available work, their advancing age, and lack of English skills. They can become socially and culturally isolated while their younger family members can quickly become Americanized and more easily mainstreamed outside the home. This gap can create a fundamental role reversal:  the elders no longer have power, money, or land, and become financially dependent on their children. Because they are culturally uprooted and isolated, they are no longer sought after for advice.

This creates much tension in many families where elders feel ignored and disrespected, while their children become more culturally proficient and easily adapt new ways of living, which alienate their elders – new cultural norms and alien behaviors that are disapproved by the older generation or in the old country. Many of the jobs available in the US are of lower status and only fit the expectations of refugee women, but not of refugee men. Many refugee men have been forced to take work with much less status and money than what they once had, or could have had in the now defunct Republic of Vietnam. This reality has created a situation where many families are dependent on the income of the mother, who is typically more versatile and patient in adapting to a new culture as well as less suitable, less prestigious jobs, all for the sake of the family.  This reality also requires readjustment of family roles and expectations.  New or expanded roles assumed by Vietnamese women in America as primary bread-winners also caused the traditional family system to alter.

A note should be made about the role of women in 20^th-century, non-communist Vietnam that produced the influx of refugees into the U.S.  Historically, Vietnam was basically an agricultural society that encouraged and approved of polygamy.  Second wives or concubines became ways to preserve family assets such as land and rice fields, or to obtain additional labor for the agricultural family. Polygamy became a status symbol, or a way of life that indulged men’s polygamous behaviors. Autocratic interpretation of Confucianism also imposed subservient roles upon Vietnamese women, as men were officially heads of households, property holders, and decision-makers. Women therefore were conditioned to accept subservience as virtues.  Arranged marriages and polygamy became norms and facts of life, often indicative of landownership, wealth and social class, while free love or individual choices were not encouraged.  (In communist North, marriages were often arranged by the Party or by party affiliation)

Despite Western influence and exposure to French education and urbanism, during the Vietnam War, Vietnamese men were utilized in military services and were often sent to faraway posts – situations that enabled polygamy and extramarital affairs.  Facing death every day, or being in mobile troops, military men sought extramarital affairs or nightclub urban life on “their day off” to reinforce themselves and deny the atrocities and brutality of war.  Having multiple wives, whether formalized or unofficial, became an exhibition of male power, self-affirmation, and even display of affluence, indulged further by a Confucius society that encouraged female dependence (at times culminating into the “buy-and-sell” of daughters to sacrifice for the family, the “Tale of Lady Kieu”’s syndrome – Lady Kieu is Vietnam’s classical literature, a novel in verses that featured a virtuous, beautiful, and talented young woman who sold herself to rescue her father, a victim of governmental corruption).  In the early 1960s, Madame Ngo Dinh Nhu of the Diem regime, i.e, the First Republic of [South] Vietnam, outlawed polygamy and pioneered new laws giving Vietnamese women more rights in society. She also implemented governmental abolishment of casinos and  nightclubs, even forbidding couple dancing with “ticketing dance partners/taxi-girls,” in order to eliminate “social vices” destructive to the family system.  Unfortunately, the Diem regime collapsed due to a military coup d’etat. President Diem and his brother-advisor (Madame Nhu’s husband) were assassinated.  Madame Nhu and her children were forced into exile.  Her social reforms were eliminated with the downfall of the First Republic (the South).

Now, in the culture shock caused by immigration and America’s “freedom,” the old polygamous norm could revitalize and multiply as the need for emotional solace and self-assurance became more imminent for Vietnamese immigrants who had suffered far too much. It is cynical, however, that most refugee men now have no more authority or economic power in order to practice polygamy.  Family breakup, domestic violence, infidelity, extra-marital affairs and betrayals, alcoholism, juvenile delinquency, as well as the rupture of negative emotions, shattered ego and physical health deterioration all lead to self-destructiveness, including suicide, and abuse could have happened behind doors, between in-groups within the ethnic community, unknown to the mainstream world.  In particular, paranoia developed from the treacherous time spent in re-education camps and horrendous escape at sea or on foot could be transferred into marital paranoia suspecting the spouse for infidelity or promiscuity, leading to domestic violence. These grave issues, as well as increased divorce rates or abandonment, should seriously be studied by sociologists. Yet, accurate data were not volunteered nor easily obtained due to the psychology of shame and fear and the reclusiveness of the ethnic culture.  However, all such tragedies are not subjects of study for this research of the elderly population, although these issues could be part of the depressive cycle or constitute causes for mental illnesses.

At the same time, it is the values of the age-old Vietnamese family system that seemed to account for the many success stories of the Vietnamese community and its rapid upward mobility in America.  For example, the children often did so well in school, and many parents worked so hard to start successful businesses.  Vietnamese refugees often ranked in the top percentile of universities and colleges.  By now, into the 21st century, they have run for public offices and have appeared among the U.S. list of millionaires and policy-makers.  Yet, under the glittering façade of success and quick survival was the prolonged pain and sufferings underneath, where dilemmas of the elderlies should rank as top priority for community unity and action.

In this regard, it must be noted that the cultural transition also leads to decline of the traditional extended families, as well as the emergence of nuclear families as the predominant form for the new Vietnamese family structure. Aside from the collapse of an extended family system, difficulty with English and the American way of life, intergenerational conflicts, and severe limitation of social communication, Vietnamese elders have also been struggling against physical illnesses from their past persecution, and many continue to be emotionally tortured with horror stories about their family members, friends, and colleagues who were killed or imprisoned in re-education camps, or simply did not make it to America.

In sum, many new Vietnamese immigrants from the older generation find themselves in a strange and unpredictable environment that contradicts and discards their old moral values and sense of self-worth, not to mention the pain, anguish, bad experiences and stale norms brought over from the former homeland. Despite their newly found freedom, better living conditions, better infrastructure and physial comfort in America, Vietnamese elderlies frequently suffer from physical weakness, rapid aging, homesickness, and language barriers, as they have to adjust to economic, cultural, political, and social changes. For many immigrants and refugee families, there is a sudden lack of the extended family’s support when it is most needed. The isolated family unit transported from the old country, for the first time, is made responsible for meeting a new environment with its strange demands. Yet, the head of the family – the elders – no longer can claim control and respect. When the stresses are extreme and the support system insufficient, the family may become enmeshed and disengaged, easily leading to depression or thoughts of suicide.  The loss of freedom created by re-education camps and the oppressive, discriminatory communist regime is now replaced by a new kind of loss: the disintegration of the extended family system.  The support it once could provide to its emotionally dependent members typical of the home culture has disappeared together with the nation-building dream of the now defunct Republic of [South] Vietnam.  After the loss of a country, loss of comrades, career, friendship and even loved ones,  not to mention persecution by the communist regime, the surviving Vietnamese elderlies who successfully crossed the ocean find themselves emotionally abandoned and cornered at the end of the road.

4. Conclusion

As of the beginning of the millennium, Vietnamese people from the South had experienced three decades of miserable and devastating events under the harsh communist regime. With the fall of Saigon, they underwent a drastic life change, suffered from various forms of persecution, and many lost everything:  power, reputation, self-esteem, property, land, belongings, food, freedom to travel and work. They witnessed their loved ones who were sent to, or died in, re-education camps. Many witnesses the deaths and tortures of their loved one at sea or on deserted islands in the Pacific.  In America, they even lost their language in mainstream society. One elderly from the old generation, a former renowned poet, lamented in verses:

“Doi nguoc ho ten cha me dat

Tap lam con tre noi ngu ngo”

TRANSLATION:

I reversed the name my parents had given me  (In the Vietnamese culture, the last name comes first, and the first name comes last, just the opposite of the American way)

I learned to babble like a child, unable to speak

To summarize,  as of the time of this 2008 case study, many Vietnamese elders were still struggling with a great deal of challenges and inevitable difficulties in adapting to the American way of life. Aside from homesickness, language barriers, and unemployment, they also faced internal family conflicts, especially in the children-parent relationship (the core of the Vietnamese family system, traditionally placed above the marital relationship, because parents were supposed to sacrifice their happiness for their children). These elderlies could become isolated, feel helpless in their total dependence on their children as role reversals. All these factors caused them to feel embarrassed, downhearted and hopeless. In the case study, the subjects often exhibited lack of energy, felt worthless, and were dissatisfied with their life.

E.  Theories of Depression

The following section is intended to give readers a theoretical background that explains the condition of depression, both in the general American elderly population and in the Vietnamese immigrant community. Medical research has contributed much to our understanding of depression.  Depression is not just a mood. It is a disease.  However, scientists do not know the exact mechanism that triggers the depressive illness. In the past, doctors believed depression was simply the result of thoughts or emotions that were troubling to the person who possessed them. More recently, experts realized that there can be several factors working together that will make a person depressed. Thus depression was an ailment and a process.

Many theories about the causes of depression exist. Four better-known theories are: psycho-physiological (biological) theory, cognitive theory, learned helplessness theory, and psychoanalytic theory.

1. Biological Theories

1. Genetic Theories

Scientists believe genetic factors play a role in some depression. Recent genetic research also supports earlier reporting of family links in depression. Twin studies consistently show that genetic factors play a role in the development of depressive disorders (Nurnberger and Gershon, 1992) — various studies of twins reveal that the average concordance rate for mood disorders among monozygotic twins (twins sharing the same genetic structure) is 60%. The percentage for dizygotic twins (separate genetic structure) is 12%. Thus, identical twins (monozygotic) have a five-fold greater concordance rate than dizygotic twins (Merikangas and Kupfer, 1995).

1. b) Biochemical Factors

Additional research data indicate that people suffering from depression have imbalance of neurotransmitters, the natural substances that allow brain cells to communicate with one another. The two main neurotransmitters implicated in depression are serotonin and norepinephrine, both of which are catecholamines. These neurotransmitter abnormalities may be the result of inherited or environmental factors, or even other medical conditions, such as cerebral infarction, hypothyroidism, acquired immunodeficiency syndrome, and drug use (Delgado et al, 1992).  Scientists think a deficiency in serotonin may cause sleep problems, irritability, and anxiety associated with depression. Likewise, a decreased amount of norepinephrine, which regulates alertness and arousal, may contribute to the fatigue and depressed mood of the illness.

Other body chemicals also may alter in depressed people. Among them is cortisol, a hormone that the body produces in response to stress, anger, or fear. Approximately half of depressed individuals studied demonstrate a hyper secretion (Green et al, 1995). In normal people the level of cortisol in the bloodstream peaks in the morning, then decreases as the day progresses. In depressed people, however, cortisol peaks earlier in the morning and does not level off or decrease in the afternoon or evening. Researchers do not know if these imbalances cause the disease or if the illness gives rise to the imbalance  — chicken and the eggs, which one comes first?  However, experts do know that cortisol levels will increase in anyone who must live with long-term stress. (See www.health:yplace.com/communities/depression/causes.asp).

2. Cognitive Theory

Albert Ellis, a well-known cognitive-behavior therapist, views emotional disturbance as the product of irrational or illogical thinking. Expanding on Ellis’s work, Aaron T. Beck applied the cognitive-behavior theory to depression. Beck proposed that people acquire a psychological predisposition to depression through early-life experiences These experiences contribute to negative, illogical, and irrational thought processes that may remain dormant until they are activated during time of stress (Beck and Rush, 1995). Beck believes that three automatic negative thoughts are responsible for people’s becoming depressed. These three thoughts form what is described as the “Beck’s cognitive triad”:

1. A negative, self-deprecating view of
2. A pessimistic view of the
3. The belief that negative reinforcement (or no validation for the self) will continue in the

This cognitive triad seems to be consistent in all depression, regardless of clinical subtype. Basically, Beck’s “Automatic Negative Thoughts” refer to thoughts that are repetitive, unintended, and not readily controllable (Haaga and Beck, 1992).

3. Psychoanalytic Theory

According to psychoanalytic theory, depression is triggered by a loss, and the depressive mood is the result of aggression turned inward toward the self.

1. Loss

Freud, in his classic, Mourning and Melancholia (1917), identified both grief and depression as reactions to a real or a symbolic loss. When people lose a crucial source of security, they may become depressed. A sense of helplessness and hopelessness is central to the experience of depression (Elizabeth, 1998). Earlier studies supported the relationship between (i) the early loss of a parent (death or divorce) and (ii) the increased incidence and severity of depressive illness in an individual’s later life (Ripley, 1997; Bowlby, 1961). However, an analysis of studies of adult depression as resulting from childhood or incidents of parental loss offered little evidence to support a link between earlier parental death and depression (Parker, 1992).

1. Aggression

Psychoanalytic theory states that depression is the result of anger turned inward against the self. The source of anger as an emotional phenomenon becomes a troubling area for further studies and analysis. However, for the past 15 years, the focus of studies of mood disorders has shifted from psychoanalytic aspects to inherited biological aspects of these disorders (Mendelson, 1992).

4)   Theory of Leamed Helplessness

One of the most popular theories on the cause of depression is Martin Seligman’s theory of learned helplessness. In his study (1973), Seligman stated that although anxiety is the initial response to a stressful situation, anxiety is replaced with depression if a person feels that the self has no control over the outcome of a situation. A person who believes that an undesired event is his or her fault and that nothing can be done to change it is prone to depression.  A study by Gulesserian and Warren (1987) found data supporting the theory that “depression is linked with poor adaptational/coping abilities that may lead to learned helplessness, panic and depression.” The lack of the following specific coping skills appeared to increase the likelihood of depression: social support, tension-reduction skills, and effective problem-solving skills (Elizabeth, 1998).

About the author & Editors

Dr. Huyen Duc Duong, M.D., M.S., graduated from the University of Saigon, Faculty of Medicine, in 1972. After 1975, he also researched and practiced Acupuncture and Eastern Alternative Medicine, in addition to family practice and internal medicine. In America, he received graduate training as a gerontologist at California State University in Fullerton. A martial art practitioner and trainer (Aikido and Tai Chi), he holds a golden second belt in Vovinam, the official martial art of Vietnam.

Dr. Nhu Duc Dzuong, B.A., M.A, Ph.D. (deceased): A British Council and Fulbright Scholar, Dr. Dzuong was trained in linguistics at the University of London’s University College and the School of Oriental and African Studies, England.  In America, he specialized in bilingual education and educational leadership. From 1966 to 1967, he was Deputy for the Minister of Culture and Education (Công Cán Ủy Viên Bộ Giáo Dục), representing Minister Tran Ngoc Ninh at ASEAN and in the U.S. for the study of Social Security and Medicare, with the goal to adapt these two systems to the RVN.

A Fulbright Scholar, Ms. W. Nhu-Nguyen Duong, B.S., J.D., LLM, is a published author of literary novels, cultural essays, and law or interdisciplinary reviews.  She is a lawyer, former judge, and former law professor.  She also holds interests and received training in journalism, drama, psychology, and music.