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Ms. Lu Yingying is a 32-year-old woman from Shenzhen, China, who has been engaged in individual psychotherapy with this evaluator since October 2025. In April 2026, counsel of record JJ Zhang, Esq. (CA Bar #326666) of Tez Law Firm requested a formal psychological evaluation in support of Ms. Lu’s application for asylum. This evaluator agreed to conduct that evaluation while maintaining the existing therapeutic relationship — a dual role considered carefully before being accepted, and disclosed in full in the Evaluator Qualifications section below.

Clinical interviews were conducted on June 5 and June 12, 2026, totaling approximately five hours. Both sessions were conducted entirely in Cantonese, the native language of this evaluator and Ms. Lu, without interpreter. Direct linguistic access — without the mediation of translation — shaped the quality of the clinical data gathered and this evaluator’s confidence in its reliability.

This evaluation was undertaken to assess Ms. Lu’s current psychological functioning, to determine whether her reported symptoms are consistent with the persecution she describes, and to provide the court with objective clinical findings relevant to her asylum claim.

Evaluator Qualifications & Methodology

Phu Luu, M.S., LMFT, is a Licensed Marriage and Family Therapist in the State of California (License #96859; NPI #1558792473), licensed since October 31, 2016, with over thirteen years of clinical experience. Clinical focus encompasses trauma, PTSD, and complex PTSD assessment and treatment, with emphasis on culturally responsive practice with diverse populations. Specialized training in immigration psychological evaluation has been completed, including psychological trauma assessment and forensic report writing (Marc Sadoff, LCSW; PESI). A copy of the evaluator’s curriculum vitae is attached.

Dual Role Disclosure: Ms. Lu initially presented for individual psychotherapy in October 2025. This evaluation was subsequently requested by counsel of record, JJ Zhang, Esq., in connection with Ms. Lu's asylum proceedings. Upon clinical determination that a formal psychological evaluation was appropriate and within scope, this evaluator agreed to conduct the assessment in a forensic capacity while maintaining the existing therapeutic relationship. This evaluator did not undertake this dual role lightly; while an independent evaluation is generally preferred, the limited availability of Cantonese-speaking clinicians with training in immigration evaluations in this region made this arrangement the most clinically appropriate course of action. The clinical findings and conclusions documented here were drawn from direct clinical interviews, behavioral observation, and standardized screening, reached independently of the legal documentation prepared in connection with these proceedings.

Background

Ms. Lu is a 32-year-old woman born and raised in Shenzhen, China. She is the mother of one son. Prior to the events described herein, she described her life as stable: she completed her education, had begun to establish herself professionally, and was married.

When she was approximately twenty years old, she became pregnant with a second child. When she sought prenatal care, she was informed she was not permitted to carry the pregnancy to term. Despite her refusal, she was transported to a government hospital and subjected to a forced abortion. An intrauterine device was also inserted without her full and voluntary consent. She reported being explicitly threatened with consequences if she did not comply.

She became pregnant again. Aware of what was likely to follow, she left the prenatal appointment. She told this evaluator: “I made up my mind. I was going to protect this child no matter what.” Several days later, officials came to her home and transported her to a hospital. Despite her resistance, the second forced abortion was performed. The pregnancy was further along than the first. She stated in session: “The second time… the baby was already…” She stopped. After a long pause: “Sometimes I still feel it. In my arms. Like… like I’m holding something. I know it’s not there. I know. But.” She did not finish the sentence.

Both she and her former husband described an “earth-shattering” change in her personality following the second procedure. The marriage deteriorated and ended in divorce. She raised her son on her own; her former husband was not involved and provided no support. Since arriving in the United States, Ms. Lu has formed a new relationship.

Prior to her departure, she began posting criticisms of government policies on WeChat. Government authorities responded by coming to her home without notice and delivering an explicit warning: if she continued, she would face severe punishment. She told this evaluator: “They were very calm about it. That was the worst part — how calm they were.” The moment they spoke, she told this evaluator, everything from the hospital came back. She had been in that position before. She knew exactly what it meant.

In the summer of 2025, she arrived in the United States with her son and applied for asylum. Her case is currently pending before the immigration court. No hearing date has been scheduled at the time of this report. Since October 2025, she has been engaged in individual psychotherapy with this evaluator. She reported no prior mental health treatment; this evaluation represents the first formal clinical documentation of her psychological history.

Clinical Presentation

Ms. Lu arrived on time for both sessions. She was well-groomed and appropriately dressed, appearing her stated age, and was cooperative throughout, though visibly anxious at the outset.

General Appearance & Motor Activity: Psychomotor activity was notable for mild agitation. She sat with guarded posture, hands held tightly in her lap.

Speech, Mood & Affect: Speech was normal in rate and volume, though she spoke more rapidly when approaching traumatic material. Mood was dysthymic and anxious by self-report, with persistent sadness and emotional numbness. Affect was restricted and congruent, with tearfulness when discussing the lost pregnancies. On several occasions she fell silent and declined to elaborate further, consistent with avoidance symptoms.

Thought Process & Content: Thought processes were logical, linear, and goal-directed. No evidence of hallucinations, delusions, or loosening of associations. No current suicidal ideation with plan or intent, though she endorsed passive death ideation, stating: “Sometimes I think… I’m just very tired. I don’t want to die. But the tiredness is very deep. My son…” She paused. “He keeps me here.” No homicidal ideation. She demonstrated good insight and fair judgment.

Cognitive Examination: Informally assessed. She was alert and oriented throughout — clear about where she was, who she was speaking with, and the purpose of the meeting. Long-term memory appeared intact; her recall of her life before the forced abortions was detailed and internally consistent. Intermediate recall was mildly impaired, with occasional loss of narrative thread when emotional arousal increased. Immediate recall was adequate. She reported chronic fatigue, reduced appetite, and significant difficulty concentrating.

Psychological Assessment & Diagnosis

The following standardized screening instruments were administered and discussed directly in Cantonese. The PHQ-9 and GAD-7 were administered using validated Chinese-language versions (phqscreeners.com). As no official Cantonese version of the PCL-5 exists, it was administered verbally in Cantonese by this evaluator, with each item read aloud, discussed, and scored collaboratively. As a Licensed Marriage and Family Therapist, this evaluator uses these instruments as clinical starting points to guide the interview process, not for formal diagnostic validation:

Instrument	Score	Clinical Significance
PTSD Checklist for DSM-5 (PCL-5)	48	Severe PTSD symptomatology (clinical threshold ≥33)
Patient Health Questionnaire-9 (PHQ-9)	14	Moderate depression
Generalized Anxiety Disorder-7 (GAD-7)	13	Moderate-to-severe anxiety

Diagnostic Impressions (DSM-5)

Detailed Symptom Presentation (Aligned with DSM-5 PTSD Criteria)

Intrusion Symptoms

“I’m on that table again. The lights… it’s always the lights I see first. I’m crying but nobody looks at me. They just… they’re just doing it. Like I’m not even there.”

Ms. Lu described this recurring nightmare during the first session, speaking slowly and not looking up. She reports experiencing it frequently, waking in acute physiological distress — racing heart, sweating, disorientation — and typically unable to return to sleep. She described the medical staff’s affect as cold and expressionless. She expressed resentment toward them that has never resolved.

She also reports a separate recurring dream in which the child — or the child’s presence — visits her. She wakes from these with grief rather than fear. She has never had the opportunity to mourn these losses formally. These visitation dreams are, in my clinical view, the mind returning to what was taken.

During the interview, while describing the second procedure, she paused mid-sentence and placed both hands across her abdomen, remaining still for approximately thirty seconds. I paused the interview. She exhaled and signaled she was ready to continue. I noted what appeared to be a somatic intrusion — a bodily response to traumatic memory she did not put into words.

These presentations are consistent with intrusive re-experiencing and traumatic grief: recurrent, distressing intrusive memories with physiological reactivity, alongside unresolved bereavement.

Avoidance

“Pregnant women, I just… I can’t look. I have to turn away or leave. My whole body… I don’t know, it just reacts. I feel it in my stomach.”

She said this with resignation, as though describing something she has long since accepted about herself. As the session moved into this material, she became tearful.

The avoidance is wide-ranging. She does not attend social events where young children are present. She declined a friend’s baby shower. She avoids medical settings when possible and reports anxiety before clinical appointments — including sessions with this evaluator — that begins hours in advance. She avoids news related to China’s government and family planning policies.

She also expressed anger. She said she felt violated — her word, used directly. She carries resentment toward the government and the system responsible for what was done to her. She does not voice these feelings to others. She stated that doing so is an offense in China, and that most people from her community are too afraid to say such things, even among themselves. I noted that she has had no outlet for these feelings and no safe space to express them. The online posts she made prior to her departure were, in my clinical view, the first time she had expressed them directly.

These patterns reflect pervasive avoidance of trauma-related stimuli: avoidance of external reminders, suppression of trauma-related emotions, and withdrawal from situations associated with the traumatic events.

Negative Alterations in Cognitions and Mood

“I know it wasn’t my… I know. But I still…”

She paused, looked down, and did not continue for a moment. Then: “I feel like I let them down. Both of them. I don’t know how to explain it. I just do.”

The self-blame has persisted for years despite her awareness that what happened was not her choice. She describes herself as having become a different person — her words — and refers to this without elaboration, as though it requires none. She referenced 老天 (Heaven, or the moral order governing fate and consequence) and 因果 (karma, the principle that actions carry consequences), questioning whether what was done to her was somehow fated or deserved. This is a culturally specific form of self-blame rooted in a cosmological framework rather than personal logic — and no less painful for it. The grief and shame have not resolved. She has had no opportunity to process them and no cultural space in which to name these as losses she had the right to mourn.

She also reported ongoing difficulties with physical and emotional intimacy within her current relationship, which she attributes directly to what was done to her body. She did not expand on this.

These findings are consistent with persistent negative alterations in cognitions and mood: persistent self-blame, unresolved grief and shame, and diminished capacity for emotional closeness.

Alterations in Arousal and Reactivity

“That warning… I knew it immediately. The moment they spoke, everything came back. I was back there again.”

She identified specific words that trigger a strong physiological response: 不合规 (out of compliance), 必须 (must), 政策 (policy), 严重后果 (serious consequences) — the words officials used during the forced abortion procedures. Hearing them in any context activates the response.

She also identified certain phrases as triggering: 看开点 · 睇开啲 (move on / don’t dwell on it), 想开点 · 谂开啲 (try to think past it), 放宽心 (let it go). These are common expressions of consolation in Chinese and Cantonese-speaking communities. For Ms. Lu they are not comforting — they reactivate the silencing that followed, not the events themselves.

Chinese-language dramas and films can also be triggering when the settings, voices, or authority figures are similar to what she encountered. She has largely stopped watching them.

Medical environments are activating. The overhead fluorescent lighting — she named it, and it appears in her recurring nightmare — is a consistent trigger. Being asked to lie down in a clinical setting is particularly activating. She is also easily startled by sudden sounds. Chronic hypervigilance, disrupted sleep, and irritability she describes as unlike herself before these events are all present.

These findings are consistent with marked alterations in arousal and reactivity.

Other Symptoms

She described her recall around the period immediately following the first forced abortion as “foggy.” She found it difficult to construct a clear timeline and could not access certain details at all. This is clinically consistent with PTSD-related dissociative processing — the mind managing the most violating aspects of the experience by disrupting how they are encoded and retrieved (Herman, 1992). It does not undermine the validity of her account. It is characteristic of it.

It was during this period that an intrauterine device (IUD) was inserted by government officials without her full and voluntary consent, as a state enforcement measure. She reports the device was eventually expelled spontaneously. Her memory around this period is where the fragmentation is most pronounced.

She reports persistent physical symptoms she associates directly with the procedures: chronic pelvic discomfort, fatigue, and disrupted appetite. These have not resolved.

She carries grief that has never been formally processed. In Chinese cultural tradition, the 婴灵 (the spirit of a lost pregnancy) is believed to wander if not ritually released through 婴灵超度 — a ceremony in which monks or priests help the spirit pass on peacefully. Ms. Lu has never had access to this. In mainland China, religious and cultural institutions operate under state regulation. There was no pathway to such mourning that functioned independently of that system, and no sanctioned space — cultural, social, or spiritual — in which to acknowledge these losses. She noted that 清明节 (Tomb Sweeping Day), when Chinese families visit the graves of their deceased, is particularly difficult. She has no graves to go to.

Cultural Considerations

This evaluator and Ms. Lu share Hakka (客家) heritage — a background that informed the cultural literacy brought to this assessment.

Motherhood is central to a woman’s identity and social standing in Chinese culture. The loss of two pregnancies through state force constitutes not only a clinical trauma but a profound injury to her sense of self.

Psychological distress in Chinese cultural frameworks is frequently expressed somatically rather than through direct emotional language. Her presentation — chronic pelvic discomfort, fatigue, and physical reactivity — is consistent with this pattern.

Her references to 老天 (Heaven, or the moral order governing fate and consequence) and 因果 (karma, the principle that actions carry consequences) reflect a cosmological framework characteristic of Chinese and Hakka cultural belief — one through which suffering is given meaning, and through which self-blame can become indistinguishable from theology. I recognized these references immediately and understood their weight.

Her silence about the causes of her divorce, even to close family members, is culturally coherent. Reproductive trauma that intersects with state power carries particular stigma. Her silence is not inconsistency. It is self-protection.

Consistency & Validity of Presentation

Across both sessions, Ms. Lu’s account was detailed and internally consistent. Her symptom presentation — the specific triggers she identified, the particular form her nightmares take, the somatic responses observed in the room — is clinically coherent with the history she describes. Individuals who fabricate trauma typically present with more uniformly dramatic symptoms; Ms. Lu’s presentation included fragmentation, avoidance of certain subjects, and moments where she could not continue — all characteristic of genuine traumatic experience rather than fabricated distress. Her core narrative remained stable. These data tend to persuade me that the diagnosis is valid.

Causal Analysis & Functional Impact

In my clinical judgment, Ms. Lu’s diagnosed conditions are directly and causally related to the persecution she experienced in China. The presenting symptoms — their timing, content, and clinical character — are consistent with state-mandated forced abortions, the non-consensual insertion of an intrauterine device, and subsequent government action directed at her political speech. These forms of persecution fall within the protections established by the Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA), which explicitly recognizes individuals subjected to forced abortion or involuntary sterilization as having suffered persecution on account of political opinion.

Functional Impairments

Ms. Lu reports significant functional impairments including:

• Significant difficulty managing the full demands of parenthood while carrying the weight of severe and undertreated trauma, imposing continuous strain on her daily functioning
• Occupational instability, including periods of difficulty maintaining employment due to concentration deficits, emotional dysregulation, and chronic fatigue
• Significant ongoing difficulties with physical and emotional intimacy, directly attributable to the bodily violations she experienced; these challenges contributed to the breakdown of her prior marriage and continue to affect her current relationship
• Social withdrawal, including avoidance of gatherings where young children or pregnant women may be present
• Chronic somatic symptoms limiting physical functioning
• Pervasive grief impairing her capacity for joy, forward planning, and engagement with daily life

Prognosis & Risk if Returned

With continued trauma-focused treatment in a safe environment, Ms. Lu has a fair prognosis for gradual improvement. Ms. Lu is engaged in ongoing individual psychotherapy with this evaluator and is making slow but consistent progress. Her symptoms, however, remain significant.

Risk if Returned to China

In my professional opinion, a forced return to China would pose a severe and foreseeable risk of acute psychological deterioration on two distinct grounds. First, returning to the country where the forced abortions occurred, where the hospitals, officials, and environments associated with the trauma exist, would constitute direct re-exposure to traumatic stimuli, triggering severe re-traumatization and worsening of all current diagnoses. Second, prior to her departure, Ms. Lu received an explicit in-person warning from government officials regarding her online political speech, with a specific threat of severe consequences. As she described it, the warning was not abstract: officials came to her home and confronted her about her speech directly, naming the punishment she would face if she continued. China maintains extensive online monitoring infrastructure, and individuals who have been flagged for political speech, as Ms. Lu has been, remain on record. Her return would place her in direct contact with authorities who have already demonstrated both the willingness and the capacity to surveil and confront her in her own home. There is an active and documented basis for her fear of renewed political persecution upon return. Continued safety and access to mental health care in the United States are essential to her stability and recovery. Her son (also named as a respondent in these proceedings) would share directly in the consequences of any forced return.

Conclusions & Recommendations

Ms. Lu carries the psychological consequences of two state-mandated forced abortions, an intrauterine device inserted without her consent, and a government warning that reactivated everything that preceded it. She carries these in the specific ways documented throughout this report: in nightmares that recur several times per week, in the words that stop her, in the grief she has never been permitted to formally name, in the physical symptoms her body has held for over a decade, and in the dreams in which the children visit her still.

The diagnoses documented here — PTSD (Chronic), Moderate Major Depressive Disorder, Generalized Anxiety Disorder — are not separate from what she experienced. They are its direct result. Her account was internally consistent across both sessions, clinically coherent, and supported by standardized screening. PCL-5: 48. PHQ-9: 14. GAD-7: 13. No indicators of malingering were identified.

Her prognosis with continued treatment is fair. Without it — without the safety she has found here — it is not. Return to China would not be a return to a neutral environment. It would be a return to the sites, institutions, and officials associated with her trauma, in a country where the circumstances she describes have not changed, and where she has already been warned that continued speech will carry consequences.

This evaluator supports Ms. Lu’s application for asylum.

Treatment Recommendations

I recommend the following:

• Continued individual psychotherapy — ongoing trauma-focused treatment, with attention to somatic work and grief processing for the losses associated with the two forced abortions
• Psychiatric consultation — evaluation for psychopharmacological support, specifically targeting sleep disturbance, depressive symptoms, and anxiety that have not fully responded to psychotherapy alone
• Parenting support — Ms. Lu is managing significant trauma alongside the full demands of parenthood; adjunctive support in this area is clinically indicated
• Somatic therapy — body-focused interventions are specifically indicated given the nature of Ms. Lu’s trauma, which is centrally rooted in bodily violation; continued somatic work is expected to address the physical symptoms and phantom sensations she continues to experience

Ms. Lu’s prognosis for improvement is contingent on continued safety, stability, and uninterrupted access to mental health care in the United States. Disruption of treatment through removal would, in my clinical opinion, result in significant setback and acute deterioration.

References