A 55-year-old Chinese American woman is referred by her primary care provider for psychiatric evaluation after extensive medical workup for chronic headaches, chest tightness, epigastric discomfort, dizziness, and generalized body pain over the past 6 months yielded no organic findings. She has seen cardiology, gastroenterology, and neurology with normal results. During the psychiatric interview, she denies feeling sad or depressed when asked directly but reports she has lost interest in activities she previously enjoyed including mahjong with friends and cooking for her family. She describes herself as feeling tired all the time with poor sleep and decreased appetite resulting in a 12-pound weight loss. She scores 4/10 on a visual analog mood scale but notes she doesn't think of her problems as emotional. When the PMHNP asks about her family, she becomes tearful and reports her husband was diagnosed with dementia last year, and she has been his sole caregiver. She states she doesn't believe in mental illness and that her family would be ashamed if she saw a psychiatrist.