At the heart of Westminster, Garden Grove and parts of Santa Ana lies a well-known but rarely admitted secret: trauma and its enduring legacy.

Nearly 40 years after the fall of Saigon in 1975, Orange County’s older Vietnamese immigrants — and by extension their families — continue to grapple with the horrors of war, communist “reeducation,” escape by boat and refugee camps. At least half a million refugees arrived in the U.S. in the decades after the war’s end.

As a result, post traumatic stress disorder (PTSD) is widespread among the county’s Vietnamese population, say mental health experts, who link trauma to depression and other problems such as domestic abuse and gambling addiction.

“Post traumatic stress is very prevalent in the community. My dad has it, I had it, I was a refugee,” said Paul Hoang, a licensed clinical social worker and the co-host of a Vietnamese community television program. He also champions mental health for Vietnamese people through his nonprofit organization, Viet-Care, in Garden Grove.

But PTSD is especially difficult to treat among the less acculturated older generation, Hoang said, because of reluctance to discuss traumatic experiences as well as attitudes about mental illness.

“There are some people who still believe that mental illness doesn’t exist. Other groups believe that mental illness is like a curse from whoever you were in the past,” said Hoang,

Another barrier to getting help has been the shortage of Vietnamese-speaking social workers and psychologists. The Orange County Vietnamese population numbers 180,000, and three-fourths of Vietnamese elders speak little or no English. Though the situation is slowly improving, only a handful of psychiatrists in Orange County are fully fluent in Vietnamese.

Further, Vietnamese people in Orange County are more likely than other Asians and ethnic groups to lack mental health coverage, according to a 2010 report, “A Look at Health in Orange County’s Vietnamese Community.”

A Persistent Trauma

The enduring signs of trauma can manifest themselves in violent or disordered behavior.

Hoang recalled treating a family in which the father, while sleepwalking in the midst of nightmares, would beat his daughter with his old army boots. “In his dream, he lost his weapon, and all he had left is his boots,” Hoang said. “Growing up, the kids were brutalized by their dad.”

Hoang also spoke of a refugee who spent many years searching for her daughter. When she finally found her child, the two could not connect emotionally and separated. The mother is now 84 and lives in an unheated garage with a dog as her only companion.

Another of Hoang’s patients had been starved for days at a time by the crew of a boat that was transporting her and other refugees from Vietnam to Hong Kong. She remembered being tossed into pitch-black water and left to swim to the bottom of a cliff or drown. And once she arrived in Hong Kong she was jailed and interrogated. These days, she is depressed and afraid to leave her room, Hoang said.

Other Vietnamese patients, while not succumbing to PTSD, are suffering from it nonetheless.

For example, it’s common for Vietnamese elders to visit their doctors complaining of pains, headache, dizzy spells or fainting, said Dr. Clayton Chau, medical director for Behavioral Health Services at CalOptima, which administers the county’s public health insurance programs. When doctors find nothing physically wrong but the patients still demand relief, they sometimes prescribe pain pills or sleeping pills, leading to overmedication.

Chau is working with primary care physicians to spot PTSD symptoms and improve treatment of aging Vietnamese patients. But he said older patients continue to resist getting therapy — even his own father. “Trauma is my specialty, and I couldn’t convince him to go to a therapist,” he said.

Communitywide problems are also likely linked to PTSD and related depression, experts say. Gambling, for example, releases the pleasure chemicals in the brain that are in short supply when someone is suffering from depression.

Passing PTSD to the Next Generation

Parents who experience nightmares, mistrust, depression and other symptoms of PTSD can pass these conditions to their children.

“It’s called the intergenerational transfer of trauma,” said Chau, who said the concept was first documented among the children of Holocaust survivors. “I treat a lot of those second-generation children.”

Young people from Vietnamese and Cambodian families in Orange County interviewed for this article report a number of ways that their parents’ traumas affected their lives. They speak of harsh punishment methods employed by their parents that border on abuse; hearing their parents cry out in their sleep at night; and an ingrained mistrust of police or anyone outside the family.

Yet the reasons for these behaviors aren’t always obvious because of silence and secrecy. College student Sandy Ninh said she wishes Vietnamese parents and elders would be more open about past hardships and their lingering effects.

She was surprised to learn that on a vacation in Venice, Italy, last year her aunt was unable to sleep due to anxieties about proximity to the water. The aunt had watched her sister drown during their escape from Vietnam by boat.

Cambodian-American college student Sara Lay talks about the moment when, as a young girl, she was confronted with the legacy of Pol Pot’s murderous regime.

While horsing around with family members, she realized her aunt was missing a toenail. She and her sister began teasing her aunt and trying to poke at the toe. Her father, who was nearby, became tense and led the two children out of the room.

He explained that the missing toenail as well as a missing fingernail were the result of torture her aunt had endured at the hands of the Khmer Rouge, who also murdered her uncle.

Culturally Appropriate Care

Through trial and error, Chau said, he has developed what he calls “culturally appropriate psychotherapy” in treating his first-generation Vietnamese patients. This involves being a more actively engaged, authoritative therapist during sessions rather than sitting quietly and making an occasional comment.

“When we go to a doctor, we expect to get something out of it,” Chau said. “You’re supposed to be helpful.”

Adapting the tools of mental health care has also paid off for Dr. Suzie Dong-Matsuda, a licensed clinical social worker and psychologist who co-hosts the TV program “VietView” with Hoang.

In particular, Dong-Matsuda has found that support groups can be very effective, and she laments the lack of resources to provide more such groups.

Talking about past traumas is beneficial, but it’s not so much about sharing feelings, Dong-Matsuda said. “It’s about telling stories. We’re a storytelling culture. … And we’re still a very collectivist culture. People feel better when they know they’re not alone.”

Another strategy is to educate Vietnamese, Cambodian and other Southeast Asian immigrants about mental health issues, said Hoang, who believes that “mental health is universal” and not a concept that only westerners can appreciate.

For Lay, it was a workshop for Cambodian college students at Cal State Fullerton last year that finally helped her make sense of how the trauma inflicted by the Khmer Rouge still haunts her family.

“They told us the first generation goes through a lot of stress and that carries on to the next generation. And they told us ‘you’re not alone,’ ” she said.

Amy DePaul is a Voice of OC contributing writer and lecturer in the UC Irvine literary journalism program. You can reach her directly at

Related stories:

Since you've made it this far,

You are obviously connected to your community and value good journalism. As an independent and local nonprofit, our news is accessible to all, regardless of what they can afford. Our newsroom centers on Orange County’s civic and cultural life, not ad-driven clickbait. Our reporters hold powerful interests accountable to protect your quality of life. But it’s not free to produce. It depends on donors like you.

Join the conversation: In lieu of comments, we encourage readers to engage with us across a variety of mediums. Join our Facebook discussion. Message us via our website or staff page. Send us a secure tip. Share your thoughts in a community opinion piece.