Xenophobia Is on the Rise Amid COVID-19—And It Has Lasting Impacts on Mental and Physical Health

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On Tuesday evening, a 21-year-old gunman opened fire at three Atlanta-area spas, killing eight people. Six of those victims were of Asian descent.

As of right now, police have not yet identified a motive for the killings—nor can they confirm the incident will be classified as a hate crime—but many suspect that the victims were targeted because of their race, and that the shootings were part of anti-Asian violence that's recently grown around the country during the COVID-19 pandemic.

Data from the non-profit organization Stop AAPI Hate confirms this rise. In a national report, published earlier in March, the organization said that it received 3,795 complaints of violence against Asian Americans and Pacific Islanders (AAPI, for short) from across the country, starting on March 19, 2020 through February 28, 2021. According to the data collected, 68% of those who issued complaints faced verbal harassment, while 20.5% were shunned (i.e. deliberately avoided). A little more than 11% were physically assaulted.

The United Nations spoke out on Twitter after the attacks, writing, "Hate speech, stigma, discrimination & xenophobia have been on the rise as a result of #COVID19. We must work together to #StandUp4HumanRights and 𝐒𝐓𝐎𝐏 all forms of racism, discrimination & hatred."

The term xenophobia (pronounced "zee-no-fo-bee-ah") has come up a lot on social media by people who are condemning the attacks. But what is it, exactly? Here's what you need to know.

What is xenophobia?

On the most basic level, xenophobia "technically means fear or hatred of strangers or foreigners," psychiatrist Jonathan Metzl, PhD, director of the Center for Medicine, Health, and Society at Vanderbilt University who researches race and health, tells Health. "Xenophobia is literally fear of people from another country or group," he adds. And, while xenophobia can technically be targeted toward anyone who is foreign (or perceived as foreign) to the US, it's largely been directed toward people of Asian descent since the start of the pandemic.

Xenophobia isn't defined as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), the main diagnostic book referenced by mental health providers across the country—but mental health providers are well aware it exists, Gail Saltz, MD, an associate professor of psychiatry at the NY Presbyterian Hospital Weill-Cornell School of medicine and host of the "How Can I Help?" podcast from iHeartRadio, tells Health.

"Xenophobia is one of the key components of the discrimination exhibited toward Asians in our country," XinQi Dong, MD, MPH, director of the Rutgers Institute for Health, Health Care Policy and Aging, tells Health. "Historically, Asians have been stereotyped as 'perpetual foreigners' and seen as a threat to American identity. Even Asians who were born here are seen as being from somewhere else." And, Dr. Dong points out, even though there are many diverse countries and ethnic groups in Asia, "Asians are seen as a monolithic racial group, regardless of ethnicity."

What does xenophobia look like?

It can show up in several different ways. "We've seen examples of this in many incidents across the country during COVID-19, in which people have reported being told to 'go back where they came from,'" Dr. Dong says.

Xenophobia can intersect with a person's race, culture, ethnicity, nationality, "and any aspects that may be used to distinguish people as 'others,' or as being different," Dr. Dong says.

People who are xenophobic "typically avoids the 'others,' dislikes or even hates the 'others,' won't interact with the 'others' and may even actively be aggressive to the 'others,'" Dr. Saltz says.

A very concrete example of xenophobia, Metzl says, is calling COVID-19, "the China virus." The term "whips up this idea that we Americans are under attack from foreigners," Metzl says, adding, "there's this false idea that the coronavirus was invented in a Chinese lab reinforces these xenophobic stereotypes, which can then lead to hate crimes and racism."

Metzl says the pandemic has only strengthened xenophobic behaviors and attitudes. "People are really afraid right now to be around people who are different from them," he says. "Even talking to strangers is a risk during the pandemic."

How does xenophobia impact victims?

Depending on the xenophobic act, it can have immediate mental health effects or build over time, Thea Gallagher, PsyD., clinic director at the Center for the Treatment and Study of Anxiety at the University of Pennsylvania's Perlman School of Medicine, tells Health. "Micro-aggressions—small acts against someone—can make people over time feel depressed, unsafe, dismissed, disconnected, and constantly feeling like they're being threatened," she says.

Even if someone is well-intentioned and makes a xenophobic comment, "it can feel very scary and upsetting for the person on the receiving end," Gallagher says.

Being the subject of xenophobic behaviors, attitudes, and actions can have a profound impact on a person's health, Dr. Dong says. His research on older Chinese Americans in the Chicago area found that discrimination is linked with depression, poorer health, and an increased risk for social isolation. "Older Chinese Americans who experienced discrimination also are twice as likely to experience suicidal ideation," Dr. Dong says.

While xenophobia can be a prejudice that people are aware they have, it can also be structural, Metzl says. That's why, he says, "calling out xenophobia is vitally important."

"Everybody has to speak out against it and make it unacceptable," he says. "A lot of times xenophobia isn't viewed the same way as racism. But if the president of the United States had said, 'COVID-19 is a Black virus,' he would have been run out of town. This can't be tolerated either."

Dr. Saltz says it's important for people to "make it clear that all humans are humans—period. That we all have differences from each other, and what is right is acceptance of differences within and outside of communities."

Dr. Dong agrees. "We must combat the myths and stereotypes about Asians that contribute to the discrimination," he says. "We can share stories and knowledge to change the narratives, and invest in research about factors that impact Asian populations, and help support Asian communities."

Dr. Dong urges people to "call out" those who use xenophobic and racist language. "We need action at every level—and especially from institutions and people in positions of power—to address the structural foundations of these problems," he says.

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