During my first week in medical school, a text buzzed on my mom’s phone. My parents were with me in Palo Alto; they’d flown in for the White Coat Ceremony and my mom had taken me to church that Sunday. We were sitting in a pew when she glanced up to see if anyone had noticed. “Did you check on Dad’s depression meds?” the message read. It was her brother, texting about their father, my Grandpa. Reading it, I felt as though I had accidentally flipped to the last page of a book. She hurriedly clicked the side button to blacken the screen. We continued singing the hymn as though nothing had happened.

I didn’t learn the word “depression” in Vietnamese until my second year in medical school, when I finally googled it. We didn’t talk about mental health in my family, likely because unbottling the trauma of the Vietnam War and of the unstable housing and food in the in post-refugee camp times that followed days would disrupt the stability they had taken years to build. Yet my intellectual journey as a medical student quickly rubbed up against the shame of mental illness in my family. I wondered if this was the same for other Asian American families with their kids fast-tracked to medical school—only to confront years of pent-up trauma later.

During my first semester, we learned about the criteria for depression. We SIGECAPped the heck out of the criteria, SketchyPharm-ed the drugs into our memory. After a couple psych lectures, I called my mother, curious about my own family history. “No, no depression in our family, she lied.

From the shuffling on the other line, I heard my dad chime into the conversation: “Just be happy. Why be depressed when you can just be happy?”

“But Baba,” I countered,” it’s not like that. “When you are depressed you can’t ‘just be happy. It doesn’t work that way.” I tried to explain my experiences with multiple roommates who’d had depression; the times I’d pulled out my phone to call the suicide hotline for friends; and the facts I’d learned in lectures about the neurobiological underpinnings of depression.

My dad rejected it all. He ended the conversation with “just be happy.” This had been his mantra, an unrelenting optimism when everything else around him crumbled during the war. He’d witnessed his brother get thrown into concentration camps, his family name put on the black list under the new government, and bomb-torn sugarcane fields. “Just be happy” was what got him through the uncertainty of whether his food-shortaged refugee boat would make it to shore. “Just be happy” was what he told his siblings, whom he would not see for decades. Yet this mantra also meant the denial of any negative emotion. When I felt angry or sad growing-up, Baba would say “just don’t think about it and the feeling will go away.” That’s also how he saw depression.

That summer my curiosity grew with the temperature. After a few months of sitting on the question, I finally gathered the guts to ask my mom directly. I opened a text message and typed, “Mom, does Grandpa have depression?”

 “Read 3:21pm” popped up instantly under the text and marinated for five solid minutes until my mom replied, “I think he does” This opened the floodgates. She called me, asked if I wanted her to put Grandpa on the line, and on a three-generation three-way call, the story of the past year unfolded. Grandpa had slowly lost his appetite and his ability to sleep. He no longer read the newspaper in the morning. At the age of 85, many of his friends had passed away, fifteen just in the past year, to the extent that Grandma had started refusing to tell him about funerals that were happening.

I asked him in what Vietnamese I could muster, “These days, what gives you hope, Grandpa?”

A pause.

“Nothing gives me hope. Maybe once in a while when the kids and grandkids visit, but most of these days, nothing really.”

I felt my stomach echo. I had heard these words before from friends. I knew how to sit with them and connect them with appropriate providers. I had heard these words before from patients, but at least they had a healthcare system where they would, I hoped, find ongoing support. But hearing these words from my grandpa, I felt like all of what he had built in the U.S., years of coupon clipping and summertime farm labor, meant nothing. I felt helpless watching my grandpa, invincible figure in my mind, crumble.

Grandma hypothesized that this wasn’t anything new, that it had started 45 years ago. In post-war Vietnam, he had been arrested by the government and placed in a concentration camp, called a re-education camp by the new Communist government even though the only “education” was how to choke down bland rice and how to not die within the confines of his own mind. They promised him that he would be released after ten days. It was three years. He left malnourished, with bilateral edema and multiple infections. Grandma said that after they released him, he had nightmares for months.

Medical school had given me a term for it: PTSD.

When I asked Grandpa when things started, he said he couldn’t remember. He replied, “it was always like this.” Only when his sleep and appetite worsened did the doctor diagnose him with depression, prescribe him Prozac, 10mg—and even then, he denied it was that. He didn’t tell any of his friends, the ones who were still alive. His shame prevented him from getting the support that he needed, even from his own children. Meanwhile, secretive texts floated among my aunts and uncles about his depression, the elephant in the room.

I could see why Grandpa reacted the way that he did. Serious trauma made him build up a defense to shut the experiences in a box, but the unconscious long-term denial of the trauma manifested as depression. A loop of trauma and masking. “Just be happy” is a defense mechanism that once served a purpose. I question if it still does.

 In my second year, I sat down with Grandpa, the two of us at his breakfast table in San Diego. He asked me how medical school was going. I told him that I was learning a great deal, an understatement. I asked him how he was sleeping and eating, the question Vietnamese grandkids ask the elders. It had been one year for him, on depression meds. His sleep had improved, but only slightly. Because of the phone call, his shame had been washed away, breedingmore openness. His children and grandchildren call and check in on occasion, even if most days he still feels without meaning.

My aunts and uncles have become less shy at unpacking the box of wartime history at family gatherings, xoi sticky rice and story time. On certain days, I feel a a slow liberation of vulnerability in our own family: maybe we’ll build a less-fragmented picture for the next generation. On other days, I feel the sine waves, oscillations of highs and lows but going nowhere.

Grandpa took my hand from the table and pressed the back of it against his nose, taking a big sniff, the Vietnamese equivalent of a kiss to a loved one.