A older person in a vintage blue dress and pearls holds hands with the person sitting next to them.

Understanding Intergenerational Trauma

The body always remembers. Like other children of Vietnamese war refugees, I understand how hardships and inconceivable loss leave marks. Psychologists in the 1990s found roughly half of Holocaust survivors were still suffering from post-traumatic stress disorder (Dialogues in Clinical Neuroscience). Emerging studies show that, in communities of survivors, trauma may also be passed onto subsequent generations through epigenetic changes, where the mechanism by which our body reads DNA – not DNA itself – is altered (Stanford University). This intergenerational transfer can also be behavioral; parents with severe anxiety may model detrimental patterns of thinking and feeling.

Intergenerational trauma is manifest amongst Southeast Asian refugees of the Vietnam-American war – a conflict that accounted for three million Vietnamese deaths and more than two million Laotian and Cambodian deaths. A 2015 follow-up study of Cambodian refugees in America found that 97% met the criteria for PTSD (Psychiatric Services). Despite the en masse resettlement of Boat People to the United States after the war, Southeast Asian communities face an ongoing struggle for access to culturally sensitive healthcare.


• Advocate for bilingual mental health support: support and donate to grassroots organizations such as Viet-CARE or sign up to volunteer.

• Participate in and share the Asian, Pacific Islander, and South Asian American (APISAA) therapist web directory with your peers and connections – you never know who may need it.

• Follow @asianmentalhealthcollective and @asiansformentalhealth to broaden your understanding of the individual mental health needs of immigrants and their children.

• Encourage compassionate dialogue about mental health.

After the war ended in 1975, the southern capital, Saigon, fell to the North Vietnamese communists, who forced thousands of South Vietnamese civilians – including my family – to surrender their homes and possessions. Facing persecution and incarceration in one of the severe “re-education” camps, thousands of Vietnamese fled by makeshift boats to safer states. Many civilians confronted pirate attacks, starvation, drowning, and rape, so their children could have a chance at freedom and a future. This generation of Southeast Asian refugees, known as the “Boat People,” constituted the largest mass resettlement of refugees in America. Over 1.1 million arrived between the 1970s and 1990s (SEARAC). Their stories are punctuated by loss, separation, and survival, reminding us that a psychological battle within the Vietnamese diaspora persists long after the physical wounds have healed.

Due to the lack of a unified resettlement infrastructure at the time, Boat People were scattered across isolated areas in the US. Without long-term support, they were expected to achieve economic self-sufficiency and independence quickly (SEARAC). Access to higher education and healthcare for these communities is still blighted by institutional inequities. But these issues have largely been overlooked and masked behind the Asian-American model minority myth, which we covered in a previous newsletter. Past traumas have been compounded by the rise in deportations amongst Vietnamese and Cambodians under Trump’s administration. Between 2017 and 2018, Cambodians saw a 279% climb in deportations (ICE).

Suppressed below the surface, traumatic memories endure not only within survivors but also within the second generation that they helped save.

Along with aching for the homeland, a paralyzing fear of being judged and rejected by their newfound society can be passed from refugee parents to children. Paul Hoang, the founder of the mental health nonprofit Viet-CARE, says children often inherit refugee parents’ anxieties around police (LA Times). In his memoir Sigh, Gone, Phuc Tran grapples with entrenched racial tensions that afflict many Asian Americans. Despite all his efforts to “fit in” when his family moved to Pennsylvania, Tran was constantly reminded that he wasn’t like everyone else. Sitting inside a McDonald’s to eat – rather than hiding out in the car – could attract racist slurs or discomforting attention from Vietnam veterans. “That was my inheritance. The anxiety of being stared at,” Tran writes.

While all of us minority settlers have a unique humor and voice, we often feel that we can only speak our minds within family homes. Outside those ethnic walls, the immigrant and the refugee are racially straitjacketed – an “othered’ status that even our children struggle to shed.

Therefore it is vital to offer emotional, long-term support that recognizes the complex journey of Southeast Asians, unique from other immigrant groups. Southeast Asian refugees still face many structural barriers to mental healthcare access, including language barriers. In my family, older relatives need my parents to accompany them to hospital appointments.

45% of Southeast Asians have limited English proficiency (SEARAC), and 95% of Cambodian refugees who had seen a psychiatrist had used an interpreter supplied by the provider or clinic (Psychiatric Services).  Patients with limited English proficiency experience a lower quality of care, higher rates of medical errors, and worse clinical outcomes than those who are English proficient (American Medical Association Journal of Ethics). This highlights the need for tailored communication methods – fundamental to accessible, effective therapy.

Additionally, while 21% of Vietnamese Americans report depression and anxiety (compared with 10% of whites), mental health remains stigmatized in these communities (UC Irvine Center). In Orange County, home to the largest Vietnamese population outside Vietnam, specialists have observed that Vietnamese Americans take a “morality view” of mental health, where mental illness reflects a person’s character (LA Times). We don’t even have a word for “depression” in the Vietnamese language.

However, in recent years, more Vietnamese and Khmer-focused counseling organizations have gained momentum. Orange County Health Care Agency provides funding for community groups like the Cambodian Family to ensure accessible health knowledge and support. The Nhan Hoa Comprehensive Health Care Clinic, designed for underserved Vietnamese Americans, started a mental health program in 2006 after seeing a need for Vietnamese-targeted programs in the county.

Healing the traumas of our ancestors has implications for the wider community and our nuanced appreciation of self-care and therapy. I have embraced the responsibility – and honor – of voicing my historically marginalized community. Archiving the “boat people” journey has sparked difficult conversations with my older relatives about intergenerational trauma, which, in turn, helps me preserve and convey Vietnamese stories in all their complexity.


• The Vietnam-American War and Khmer Rouge Regime resulted in trauma that lasts across generations, known as intergenerational trauma.

• After the Vietnam-American war, thousands of Vietnamese, known as “Boat People,” escaped the country on boats to flee communist persecution.

• Funding bilingual and bicultural therapy will help ensure all refugees have access to healthcare services regardless of their English proficiency.

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