Yale Psychiatry Grand Rounds: "Asian Americans & Racial Trauma: Does Race Matter?"

June 07, 2024

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June 7, 2024

"Asian Americans & Racial Trauma: Does Race Matter?"

Alvin Alvarez, PhD, Professor, Department of Counseling, San Francisco State University

ID11764

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00:00Much Maria,
00:03here we go. First of all, thanks so much,
00:06Maria, for that warm welcome.
00:07You know, because I'm doing this
00:09from the comfort of my home.
00:10My, my daughter actually overheard that
00:12last part where you talked her up.
00:14So she kind of giggled and really
00:18appreciated that in the midst of that,
00:19they're also wondering, who the hell are
00:21you talking to at 7:00 in the morning?
00:24And she's like, why, Why are you doing this?
00:28And my other daughter was like,
00:31and I tried to explain it and I was like,
00:33and my other daughter's like,
00:34what is a grand round?
00:36And what is it? Why is it so grand?
00:38And so I've already been
00:40stumped early in the morning.
00:42So I hopefully I, I, I can do a little
00:45bit better for your presentation.
00:46But I just want to thank you,
00:48Associate Dean Crusto,
00:50for extending the invitation for
00:52Maria giving such a warm welcome.
00:55It's an honor to join you
00:57colleagues here this morning.
00:58And hopefully, you know,
00:59at the end of this day,
01:01I can give you some food for thought,
01:04some stimulus for question and engagement
01:07and just a chance to talk really.
01:09I mean that that's really
01:10what this is all about,
01:11a chance for us to communicate about
01:13things that are important to all of us.
01:16Right.
01:17Today I wanna let me start my slides here.
01:22Make sure all of our technical prep is fine.
01:28Go.
01:31All right, Cindy, Maria,
01:32can you give me a thumbs up if you
01:35can see this and hear this? OK?
01:37All right. Perfect, Perfect, perfect.
01:39Don't wanna say pay on the reporting.
01:41All right, So as Maria said, you know,
01:46there's different parts of my career.
01:48Today I wanna join you as a clinician.
01:51I was a clinician primarily in
01:53the early part of my career.
01:55I want to show you,
01:55talk to you a little bit also
01:57as a scholar and to some extent,
01:59I also want to talk to you
02:01as an administrator and, and,
02:02and how racial trauma kind of encompasses
02:05the multiple roles in my career, right?
02:08But the through line,
02:10the through line in all this is
02:13really myself as a psychologist.
02:15And I want to take you back and
02:17I want to share with you a story
02:19about a time when I was really
02:23embarrassed and quite frankly,
02:25ashamed to be a psychologist.
02:27And this was early in my career.
02:29And I was invited at that time to lunch
02:33here in San Francisco by two lawyers.
02:36This was about 1999 or so.
02:4098,
02:41there are two lawyers from the
02:42Asian Law Caucus to discuss a
02:44case that they were working on.
02:46And what was going on was that the San
02:50Francisco Housing Authority was being
02:53sued because there was a pattern of
02:56discrimination and racial harassment
02:58and violence in the housing projects.
03:01And much of it was really targeted
03:03at the Southeast Asian community,
03:05at Southeast Asian families.
03:07And there was attacks,
03:09there was verbal harassment,
03:11there was vandalism,
03:13cars were being burned,
03:16buildings and homes were being attacked,
03:18et cetera, that kind of thing.
03:20And it was directed,
03:21as I said,
03:23primarily to Southeast Asian families.
03:25And the Housing Authority basically
03:27did nothing to stop this or
03:30address any of these complaints.
03:31Right?
03:32And one of the stories involved a
03:39young mother who was walking home one night,
03:43and she was surrounded by five
03:46teenagers who yelled all this up here.
03:49Get out of here, Chinese
03:51***** We know where you live,
03:54and we're gonna kill you.
03:55And they didn't know where she lives.
04:01This is what the opening line was.
04:04And then they attacked her
04:06with rocks and bottles.
04:09As you can imagine,
04:10that was traumatic.
04:11And the lawyers,
04:12as we sat there in a nice,
04:15lovely lunch,
04:18said, you know, we need you to help
04:21us to to compile the research on Asian
04:25Americans and racial trauma and so
04:29that we can obviously help to make a
04:32case that experiences like this have
04:36some impact on the mental health of
04:40these families and these individuals.
04:44And I was quiet and I didn't
04:47know exactly what to say.
04:49And finally I spoke up and I said,
04:53honestly there,
04:54there's not a whole lot done on this
04:57from a research perspective. And
05:03he was kind of quiet.
05:04He was very stunned.
05:06And he looked at me and
05:09he asked me a question.
05:12And that really kind of cut
05:13through the heart of who I
05:15wanted to be as a psychologist,
05:17who I wanted to be as a new scholar.
05:20And he said,
05:22what have you guys been doing,
05:26right? What have you guys been doing
05:28this whole time? Where have you been?
05:32And I couldn't answer.
05:35And there was a lot of shame for me.
05:38There was a lot of shame for my field.
05:41There was a lot of frustration
05:44about our efforts collectively
05:46as scholars and professionals.
05:49You know, there was no question to me,
05:51particularly in my clinical practice,
05:53that I worked with a lot of folks,
05:57not just Asian Americans,
05:58but many people of color and
06:01other marginalized groups.
06:02I worked with clients
06:04who had dealt with this.
06:05But what had we done as a field
06:07from a scholarly point, right?
06:09And the answer to that was really not much.
06:14And so let me show you why,
06:16why we couldn't help.
06:22This is a very quick summary
06:26of the professional literature on Asian
06:30Americans and racism at that point in time.
06:33Remember, this was a conversation
06:35that happened to my 9998.
06:37And why couldn't we help?
06:39Well, it wasn't just me,
06:40but it was an entire field.
06:41And these numbers, by the way,
06:43isn't just psychology, right?
06:45This is psychology.
06:47This is social work, this is counseling,
06:50this is public health.
06:51This is medicine, right?
06:53This is what we'd achieved prior to 1991.
06:58Study on Asian Americans and racism.
07:01One between a decade's worth of time,
07:061990 and 99.
07:09Six, right?
07:11And I want to put that into context.
07:12At this point,
07:13we're talking about 22 million
07:15Asian Americans in this country,
07:18and their experiences around race and
07:21discrimination was encapsulated by a
07:24big whopping total of seven studies.
07:26That's it, right?
07:27So when I was approached by the Asian
07:29Law Caucus at this point in time,
07:32right, lawyers who were trying
07:34to do their civil rights work,
07:36you know,
07:37I had to admit that there was
07:39literally just a handful of studies.
07:40So that's what we were doing
07:43from a scholarly standpoint.
07:44That's what we were doing as a discipline,
07:46right?
07:46So now let's talk a little bit
07:51and put things into context.
07:55Asian Americans history in
07:57this country is is rather long,
07:59and it began with Filipinos
08:03arriving off of the galleon routes
08:06from the Philippines to Acapulco,
08:08landing on these shores in Morro Bay,
08:11CA in 1587, right? That's 437 years ago.
08:17OK, They didn't settle there.
08:19Filipinos ended up making some
08:21of the first settlements in the
08:23bayous of Louisiana in the 1760s.
08:25But, you know, 437 years ago is when
08:28Asian Americans set foot on this shore,
08:31when they began to come here in large
08:34numbers, in large waves of immigrants,
08:36starting with the Chinese in the 1800s,
08:41they were met with the very first
08:45immigration law that targeted in that racial,
08:49ethnic group specifically with
08:51the Chinese Exclusion Act.
08:53142 years ago.
08:54You go down the line,
08:56you look at Executive Order 9066,
08:58the Japanese American internment
09:0080 years ago, right,
09:02the mass incarceration without
09:05due process of Japanese Americans.
09:08And then we moved a little bit
09:09closer to our time as the murder
09:12of Vincent Chin in 1982,
09:13which was a hallmark incident
09:15nationally that really galvanized
09:17the Asian American community.
09:19A young man who was sitting
09:21at a bar in Detroit,
09:24MI,
09:24and he was then subsequently
09:28chased and beaten with a bat
09:32by disgruntled auto workers,
09:34right,
09:35who mistakenly assumed he was
09:37Japanese American and that he
09:40was taking business away from
09:43them and taking their jobs.
09:45Those men, by the way,
09:46were never sent to jail, OK?
09:49And it kept getting overturned.
09:51So, you know,
09:52one of the through lines in all this
09:54history is that #1 Asian Americans
09:57have been here for a long time,
10:00right?
10:00Long time.
10:01But race and racism has been a
10:04persistent through line through
10:06all of their experiences.
10:08And you can also see how that has
10:10been a through line through different
10:12ethnic groups as a whole, right?
10:15So racism has been a consistent part of
10:20the lived experiences of Asian Americans.
10:21But let's talk a little bit about what
10:24is this racism thing we're talking about?
10:26There's a lot of different
10:28definitions of racism.
10:29You can look them up.
10:32But I've always been kind of
10:34particularly drawn to this one,
10:35one of the earlier ones,
10:36which is from Doctor James Jones.
10:39And what I like about this particular
10:42thing is that it underscores
10:44that it is not just an attitude.
10:47It is not just a belief, right?
10:50It's not just a prejudice.
10:52Anybody can be prejudice.
10:54Anybody can have a bias, right?
10:56What is striking about this
10:59particular belief system is that
11:02it is a system of beliefs, right,
11:05that is legitimized and reinforced by power.
11:09And power is the crux and the fulcrum
11:11on which this really rests on,
11:13right?
11:15And power is exercised through individuals
11:18and institutions so that it becomes the norm,
11:22that this becomes the way we do things.
11:25This is the way life should be and can be,
11:29right?
11:29So it is not just a belief or an attitude,
11:32but it is a belief that is fueled really by
11:37institutional and cultural sanction.
11:46So today I want to just focus and
11:49highlight a few types of racism. And again,
11:51this is just kind of a very one model.
11:55This is also Jones's model that he looks at.
11:59And I I like this one because it
12:01really begins to highlight the
12:04differences between individual,
12:05institutional and cultural right.
12:08And there are clear overlaps
12:10across all of these things,
12:12but it really for our purposes,
12:14gives us some clarity in understanding this.
12:17Scholars since Jones's work have really
12:19elaborated on different forms of racism,
12:22for instance,
12:23intergenerational racism or vicarious racism.
12:26But for now,
12:27I just want to hold us to just these three
12:29because it gives us some focus and clarity.
12:32So let's talk a little bit about,
12:34well, racism. This is the definition.
12:36We're gonna work with this framework.
12:37What does that look like within
12:39the Asian American community?
12:43Well, individual racism is defined as,
12:45you know, individuals acting
12:47upon their beliefs, right?
12:48Acting upon the belief that one
12:51group is superior to another,
12:53another group is inferior, right?
12:55Acting on the belief that another group is
12:58being othered and distanced and less than.
13:00And you can see that throughout
13:03Asian American history,
13:04from its inception,
13:06from the time we first began to come
13:08to this country in large numbers,
13:10we have been met with individual
13:13racism by virtually every group.
13:16Since the very first anti Asian
13:19rioting that happened in LA in 1871.
13:22All the way through the
13:24Japanese internment, through
13:29the Filipino riots in Watsonville to
13:32more recently the Atlanta shootings,
13:34as well as some of the things
13:36that happened as a result of and
13:39related to the COVID pandemic.
13:41So racism and direct violence
13:44has been a consistent part of the
13:47experiences of Asian Americans.
13:49And we can see that in recent years
13:52in the next slide, it's spiked.
13:55And I, I wanna take a moment here
13:58to just really honor the work of my
14:01colleague here at San Francisco State
14:03University, Doctor Russell Jung.
14:04We're really beginning to give
14:07us some of the most powerful and
14:09recent tallies of what is going on
14:12within the Asian American community.
14:14Now, this isn't not the first time
14:17there's been a national attempt to
14:20really capture what is going on in
14:23terms of Asian American racism and hate,
14:26but this is a striking example
14:28and it got a lot of press.
14:30You can see here that between,
14:33in a 1 1/2 year time span between
14:35March 20th and September 2021,
14:38there'd been over 10,000 incidences reported.
14:41OK, to give you a,
14:43a kind of a benchmark of just
14:45the significance of that number,
14:47there was a civil rights consortium
14:51of the National Asian Pacific
14:53American Legal Consortium out of DC.
14:56They used to do this in the early 90s
14:58and stuff and they used to produce an
15:01annual report of this of anti Asian violence.
15:04And on average, at that point in time,
15:08they were kind of cataloging about 200
15:12to 500 incidences of racism annually,
15:16OK, two to 500 incidences annually.
15:19So when you get a report like this,
15:22that really skyrockets to over 10,000.
15:25That's a substantial spike,
15:2710,000 in just a year and a half.
15:31So it's staggering.
15:32You can see that about 20% of
15:36Asian Americans, right?
15:37And Pacific Islanders experienced a
15:39hate incident within the past year.
15:42Many of these were really targeted
15:44at kids and at women.
15:46A lot of this really involved verbal
15:51harassment for the most part.
15:53But as you have probably seen in the news,
15:57you know,
15:58there was a number of incidences of beatings,
16:02you know, people getting pushed,
16:04people getting killed,
16:06etcetera.
16:06So there was a significant spike
16:09in many of these incidences.
16:16So let's talk a little bit and
16:19shift to institutional racism.
16:20And what you can see on the right
16:23hand side of your screen here is
16:25the actual Executive order 9066 that
16:29was distributed by the government.
16:31And I'm not gonna go over
16:34every little piece here.
16:35And but, you know,
16:37many people are familiar with
16:38the Chinese Exclusion Act.
16:40What many people don't know is that
16:43that was just actually a part of a
16:46series of immigration legislation that
16:49targeted specific groups of Asian Americans,
16:52not just Chinese, right,
16:54and had an impact on the
16:55Japanese American community,
16:57the South Asian community,
16:59the Filipino community, et cetera.
17:02You can see other types
17:04of institutional racism,
17:05whether they be restricted covenants that,
17:08you know, limited folks for where they live.
17:11That, of course,
17:12did not just affect the
17:14Asian American community,
17:15English only initiatives,
17:17glass ceiling barriers,
17:19accent and language discrimination,
17:20et cetera.
17:21So again,
17:22the point here is that these institutional
17:26forms of racism affect the economic,
17:30the social, the educational,
17:32the marital rights of Asian
17:34Americans consistently,
17:36right?
17:42But what is the connection between
17:45individual and institutional racism?
17:47And this is where I I think
17:50Jones's framework really helps.
17:52The bridge and the fuel behind any
17:54form of racism is cultural racism.
17:57And what is that?
17:58Well, cultural racism are the beliefs,
18:01the assumptions, the stereotypes that
18:05people hold that fuel and give tacit
18:09approval and explicit approval to
18:12individual and institutional racism.
18:14It's the gas, right?
18:16It's the, it's the gas that fuels the
18:18engine of racism and that makes it OK.
18:21It's the belief system that underlies
18:23it that makes this OK, right?
18:26And these are just some of the belief
18:29systems that we have seen and we have
18:33catalogued the scholars that have been
18:36targeted specifically at Asian Americans,
18:37including the model minority myth,
18:39the belief that, you know,
18:40Asian Americans are doing fine,
18:42they're wealthy, they're successful,
18:44they're high achieving, et cetera.
18:47And all, all to, you know,
18:49the perpetual foreigner that
18:51Asian Americans never quite fit,
18:53they're never quite belong.
18:54No matter how many generations you're here,
18:56somebody is still going to
18:58ask you where you come from,
19:00how do you speak English well,
19:01right, et cetera.
19:03So cultural racism is really the engine,
19:08the the foundation that allows
19:11individuals and institutions to act
19:13in ways that are seen as Norman.
19:16Like,
19:16as long as you act within these
19:18particular behaviors, that's fine.
19:24So as you can see,
19:25and part of the impetus for this is,
19:26you know, since COVID-19,
19:28there's really been a peak of
19:31anti Asian racism and trauma,
19:34which is why a lot of times I've
19:36been invited to do these talks.
19:38But the piece that I want to
19:41really under score here and the
19:43thing that I want you to hopefully
19:45just appreciate is that what you
19:48see before you is quite literally
19:50just the tip of the iceberg.
19:53You know that the depth of racism
19:56and trauma that the Asian American
19:59community has experienced.
20:02Isn't just about what happened
20:03with COVID-19 and a virus.
20:04What happened in recent years is not
20:07a single incident or even a series of
20:10incidents related to a virus, right?
20:12It's a long standing pattern of
20:14incidences that have resulted from the
20:17belief that Asian Americans can be other,
20:20can be less than,
20:22can be pushed out our outsiders.
20:24So it's not about a particular
20:27virus that happened, right?
20:29The virus and the pandemic gave us
20:32tacit permission to act on beliefs
20:35that have been with us since Asian
20:37Americans stepped on these shores,
20:39right?
20:39And it's been with this country
20:41then for the long time.
20:43It's just the most recent iteration.
20:45And you can take a look at some of
20:48the things that are on these slides.
20:50So that's the history part.
20:52I'm gonna shift now.
20:57So, you know, is this really a big deal?
21:00Does it really matter?
21:01That's the whole point of this talk, right?
21:03Does it? Does it doesn't matter?
21:05Are these incidences really harmful?
21:09And what I want to show you here,
21:12these are items from probably one
21:14of the most commonly used scales,
21:16the everyday discrimination scale
21:18that David Williams and his colleague
21:22up in Harvard had developed.
21:24And, you know, public health has a number
21:29of wonderful ways of assessing this.
21:31But, you know, these are some of the items,
21:33you know, you are treated with
21:35less courtesy than other people.
21:36You're insulted.
21:37You're called the name, you know,
21:40you're ignored and lying at a
21:41restaurant or something like that.
21:43You know, and these touch on what we call,
21:45you know, microaggressions,
21:46and this is one of the most common
21:49ways in the scholarship that we
21:52actually measure racism, right?
21:54And some of you on this call may
21:57have experienced some of these,
21:59many of these or all of these, right?
22:01And so the question really begins,
22:03it's like, does this really matter, right?
22:06If somebody is ignoring you in
22:08the line while you're trying to
22:10order something at McDonald's,
22:12does that really matter?
22:13Does that hurt?
22:14Right.
22:16So let's see where we're at
22:22since the story I told you earlier about,
22:25you know, my, my work with the
22:27Asian Law Caucus, you know,
22:29things have shifted quite a bit,
22:31you know, since the late 90s.
22:34And you can see there begins to be a rapid
22:39growth such that at this point in time,
22:41we're roughly looking at a little
22:44over 300 studies or so now, you know,
22:47300 studies to represent the experiences
22:51of millions of Asian Americans.
22:53Still not great, but it's a hell
22:55of a lot better than seven, right?
22:57So we're headed in the right direction.
23:01And so a little bit of what are
23:02we going to talk about today is
23:03what have we learned since then?
23:05What have we learned about this phenomenon?
23:08And to really answer that question,
23:10does this really matter?
23:14So I'm going to look at
23:15three different areas.
23:16This is the first one,
23:17which is the mental health outcomes.
23:20And this is actually where the
23:21majority of the work has focused on.
23:23And clearly it's relevant to
23:25this entire audience here, right?
23:28And, and what is the relationship
23:31between Asian racism against Asian
23:34Americans and their mental health?
23:37About 2/3 of the studies out there in the
23:41literature are focused on mental health.
23:42So there's been a really big
23:45push within public health,
23:48within psychology,
23:50social work, et cetera,
23:52to really begin to to look at
23:54what are some of these outcomes.
23:56I'm not gonna go over every
23:58single one of these studies,
23:59but I do wanna just highlight one of them,
24:02right?
24:03And one of them is a really interesting
24:05study that was done very early on
24:08by Chelsea Liu and her colleagues
24:10within the VA system in Hawaii.
24:12And what they did was they looked
24:15at Asian American Vietnam vets,
24:18Asian American Vietnam vets,
24:20and looked at their experiences
24:23of race as vets.
24:25And I want to go and contextualize this.
24:27We're talking about young men
24:29who at the time of deployment
24:31were around 2223 years old.
24:34They were going into the Vietnam
24:37theater and part of their experiences
24:40was really being identified and
24:42closely identified with quote,
24:45UN quote the enemy.
24:47And you know,
24:48them reporting experiences like when
24:50they would go on training exercises,
24:53they would say if you want to
24:54know what the enemy looks like,
24:56it looks like him, right?
24:58And that individual would point to
25:01other Asian American soldiers, right?
25:03So being really identified and
25:06targeted from day one with,
25:08you know,
25:10pejorative names like **** and
25:12***** etcetera like that.
25:13And so the question that Chalsa
25:16and her colleagues were interested
25:18in is it does the experience
25:21of that within that context,
25:24that military context does that,
25:26how does that relate it to PTSD?
25:29Well, they found out two major things.
25:32First of all,
25:34above and beyond combat exposure, right?
25:37They found, obviously,
25:39that combat exposure was related to PTSD.
25:41That was fairly straightforward.
25:43But what they also found out was
25:47that the experience of racism,
25:49right added to added to the
25:53likelihood of experiencing PTSD
25:54above and beyond combat exposure.
25:57In other words,
25:58the experience of racism was a
26:01unique and distinct stressor in
26:03addition to combat exposure.
26:05That was an interesting finding.
26:07What is more striking is that as
26:10they went through their analysis,
26:12what they found was that the
26:14experience of racism for these vets
26:17was a stronger predictor of PTSD.
26:20Let me say that again,
26:22it was a stronger predictor of
26:25PTSD than actual combat exposure.
26:27OK, so sit without a moment, right?
26:31So the experiences that you
26:34have with your comrade in arms,
26:36with people from your country,
26:39people who you are fighting with,
26:41the racism you are experiencing
26:43from within your own ranks was
26:45more associated with PTSD than
26:48actual combat exposure.
26:49That gives you a sense then
26:51of the level of
26:52trauma that these men were experiencing.
26:57Physical health outcomes.
27:00This body of work, although not as large as
27:03the work within the mental health outcomes,
27:06it is still very significant, obviously,
27:09and like the mental health outcomes,
27:12is pointing to similar patterns.
27:15In other words, that racism in general
27:18is really being associated with poor
27:20physical health outcomes, right.
27:23One particular study was one by
27:28Gilbert G and his colleagues.
27:30And you know, Gilbert,
27:32they asked participants a real simple
27:35question, how many days, right?
27:37How many days?
27:39When you think about your physical health,
27:40how many days do you believe your
27:42physical health was not good?
27:44Very simple question,
27:45how many days do you feel that
27:48your physical health was not good?
27:50When we look at the data here and
27:52we extrapolate this especially
27:54to a yearly basis,
27:55one of the things we find is
27:57that Asian Americans experience
27:59many days of being unhealthy.
28:01That was associated with
28:03their experience of racism.
28:05There is a range.
28:07Chinese Americans were reporting
28:09around 19 unhealthy days every year,
28:1219 unhealthy days.
28:13South Asians at this time were reporting
28:1751 unhealthy days as a result of
28:20their experiences with with racism.
28:22Let's think about that 51 days,
28:25that's almost two months, two months
28:29where your physical daily activities,
28:32your estimation and again,
28:34it is self report.
28:36So there are limitations here,
28:37but their perceptions of how their
28:40body was working for two months
28:43was impacted by discrimination.
28:50This is probably the smallest body
28:52of literature yet in many ways
28:55this is some of the most disturbing
28:57findings that we are seeing.
29:01And this is looking at people's
29:03health behaviors and what is the
29:06relationship between discrimination here?
29:08Probably some of the most striking one
29:10is some of the earliest work was finding
29:13that the experience of discrimination
29:15was associated not only with suicidal
29:18ideation but suicidal attempts.
29:20Right there was a strong and
29:23consistent link and this has been
29:25found in the literature repeatedly.
29:27For instance, on some of these studies,
29:29in Lee's study,
29:32Chinese American elderly were reporting
29:352 * a higher likelihood of suicidal
29:40ideation and attempts as a result
29:44of the experience of discrimination.
29:46We're also seeing, right,
29:49that health seeking has been
29:52affected so that, you know,
29:54the experience of discrimination
29:56was associated with whether
29:58or not people would seek help.
29:59And what we're finding is that,
30:02you know, Asian Americans as a whole,
30:05we've consistently documented that there
30:08is already a stigmatizing effect to
30:11seeking treatment for mental health, right?
30:13And this is only exacerbated even
30:16more so by the experience of racism.
30:19What is troubling is that look,
30:23let me see here, what is troubling here
30:27is that not only are Asian Americans,
30:30as a result of their experiences of racism,
30:34not seeking help,
30:36when they do actually seek help,
30:38they also experience discrimination
30:40from their providers,
30:42as that last bullet point is showing.
30:43So you know, what are,
30:46what are we seeing with all these slides?
30:48Number one, we're showing that racism, right,
30:53is associated with mental health illness.
30:56That's number one.
30:57Number two,
30:58racism is associated with your willingness,
31:02right, to seek treatment,
31:04and in this case,
31:05your resistance to seeking treatment,
31:07right?
31:08And then #3 that in when you
31:10do seek treatment,
31:12you end up experiencing secondary
31:13trauma as a result of your
31:15experiences with your provider, right?
31:17So you know,
31:18the experience of discrimination is hitting
31:21you literally at every point in the chain,
31:23right?
31:24From just causing illness,
31:27preventing treatment,
31:28and then giving you treatment,
31:30then that then actually creates more trauma.
31:35So what are the main lessons here?
31:41The main lessons #1 obviously
31:42is that it's pathogenic,
31:44that discrimination has a significant
31:46and adverse impact on health,
31:48mental health, and our health behaviors,
31:51right?
31:51And that,
31:52you know,
31:52while we talk about health often times in
31:55terms of biological or physical things,
31:57what this really begins to under
32:00score is the important link between
32:02one's health as well as the social,
32:04political,
32:05environmental context in which we live.
32:08The other thing,
32:09and I will kind of elaborate on this too,
32:11is that I want to remind us all the
32:13findings that I had in here were
32:15really in one of the main limitations
32:18focused on microaggressions.
32:19Yet we also know if you listen to the
32:21early part of what we talked about,
32:23racism is not about just microaggressions.
32:26And I will elaborate on that a little bit,
32:28right?
32:30So you know,
32:33one of the things too that this
32:35begins to really under score is
32:37that when you think about racism
32:39at beyond just the individual,
32:42when you understand it as something
32:45that institutions and culture
32:48propagate and perpetuate them.
32:50It really then begins to challenge
32:52us to think about what what is the
32:54role of institutions and what is the
32:56role of communities and creating
32:58these experiences for people.
32:59And when you look at it that then
33:02we're really then beginning to shift.
33:04If you're talking about institutions
33:06and communities,
33:07you're not just talking about
33:09clinical treatment at that point
33:11at all, right? Then you're really
33:13talking about systemic change.
33:14Then you're really talking about
33:16shifting some of our thinking about
33:19our roles to an advocacy role, right,
33:21as opposed to just purely clinical 1.
33:27So where are we and where do we go from here?
33:30And you know, in many ways,
33:33not as bad as when I met
33:35those lawyers back in the day.
33:37We are still kind of near at
33:39the beginning and you know,
33:41I wanna touch on a number of these
33:43issues here about racism as being
33:45multi dimensional protective factors.
33:47And then what do we do with this
33:48in terms of what do we do with this
33:50as as healers and health providers?
33:52What do we do with this in working
33:54directly with people and what do we
33:56do with this in terms of community
33:59and institutional interventions?
34:01OK,
34:05I wanna talk about where
34:07the literature was, right?
34:08And one of the things that I
34:11really wanna focus on is the
34:13literature is focused on this.
34:15Like I said earlier,
34:17this is one of the most common
34:19scales used to measure racism,
34:21not just for Asian Americans
34:24but for multiple groups.
34:26So this scale is used over and
34:29over and this is what it assesses.
34:31So when you see this literature
34:33that racism is connected with this
34:35racism is correlated with this,
34:37this is oftentimes what we're talking about,
34:39right?
34:40So we have,
34:41as you can see from the prior
34:43slides with 326 studies,
34:45we've got a sizable body of literature
34:50that gives us an answer to this kind of
34:53racism is associated with depression,
34:55with suicidal ideation,
34:58with drinking,
35:00with self esteem,
35:01with all kinds of things that
35:05we can more or less answer with
35:08some degree of confidence,
35:10right?
35:14But here's where we kind of go off script.
35:18We don't know, you know,
35:20there's other questions that
35:22racism really asks, right?
35:24There's a lot we don't know.
35:25And this slide really begins
35:27to touch on this, You know,
35:29what is the impact of getting beaten?
35:31What is the impact of having your family
35:35members murdered or watching a murderer?
35:38What is the impact of not getting
35:40a job because people don't think
35:43you can actually manage or lead?
35:45What is the impact of a hospital
35:49or an office saying you can't
35:52speak anything but English here?
35:55What is the impact of there's a law
35:58down in Florida now where Chinese
36:01families in particular are banned from
36:05buying land in certain instances.
36:07What is the impact of that?
36:09Of living with a family who
36:11couldn't buy a home, You know,
36:13what is the impact of feeling like
36:15you're not gonna get into school because
36:17you think there's an implicit quote?
36:19What is the impact of that?
36:21Fair questions.
36:22Questions that affect the
36:24realities of many Asian Americans.
36:26Do we as a body of literature and
36:29scholars have an answer to this?
36:31No, we don't.
36:32Right?
36:33Because again,
36:34the vast majority of the literature
36:37is focused on microaggressions.
36:38When we know
36:41that racism is actually multi dimensional,
36:44right? At a theoretical level,
36:47we've been able to,
36:48and at an experiential level, we know
36:50that it's more than just being ignored.
36:52In mine, we know it's more than just somebody
36:56calling us a name on the playground.
36:59There's different forms of racism and
37:01many of which have yet to really be
37:04examined in any depth. So, you know,
37:07we've taken a step forward, right?
37:09But hopefully what you really see
37:11in this slide is there's a lot
37:14of steps ahead of us, you know,
37:15a lot of steps ahead of us.
37:21The, the focus has also been much
37:23of the research has really also
37:25focused on outcomes. What is racism?
37:28How is racism related to depression?
37:31How is related related to suicide?
37:34How is it related to substance abuse?
37:37Right? It's focused on outcome.
37:39What is less clear is what
37:42are the protective factors?
37:44What actually helps you to survive?
37:46What actually helps you to thrive?
37:48What actually helps you to be resilient?
37:51And there's work and,
37:52and I've listed a couple of things here.
37:54There's work in some of these areas, right?
37:57Ethnic and racial identity, coping,
38:00social support, preparation for bias,
38:03in other words, teaching people
38:05about the experience of racism.
38:07Does that help?
38:08But it's, it's, it's,
38:10it's complicated, right?
38:11And it's not yet definitive.
38:14And a lot of these things have mixed results.
38:17For instance,
38:18some folks think that identifying
38:21with your cultural group or your
38:24racial group actually helps.
38:26And because it provides a sense of pride,
38:29it provides a sense of agency and
38:32self efficacy in the face of racism.
38:35Other studies have found it's
38:37actually the complete opposite,
38:38that identifying with your group can
38:41actually also be hard and harmful.
38:43And we theorize that some of that
38:45has really due to the fact that,
38:47you know,
38:48having something that you strongly
38:49identify with that you cherish and
38:51having that attack could actually
38:53lead to more negative outcomes,
38:54right?
38:55So there's there,
38:56there's caveats with a lot of this,
38:59but the whole message here is that
39:01we are pretty clear on the outcomes,
39:04but we're not always quite as clear on,
39:06on what are the protective factors.
39:08So there's more work to be done
39:10in this particular area.
39:17So let's talk about you all.
39:19Let's talk about the people on
39:23this call here. And you know,
39:27people often ask me, it's like,
39:29how do you work with Asian Americans?
39:30Well, first of all,
39:31my first answer is that first of all,
39:33you gotta work with yourself.
39:35You gotta hold yourself accountable
39:37right before you enter the room.
39:39There are things and questions that we
39:42need to ask ourselves as healers, right?
39:46And so that self-assessment is critical.
39:51You know, what's your experience
39:53or understanding of racism?
39:54You know, what's your own experience of
39:57privilege and its impact on people of color.
40:00And this is important because your
40:02patients will wanna know this.
40:03Not specifically ask this,
40:05but they will intuit this.
40:08Racial identity is an area of psychology
40:11that talks about the developmental
40:14process of recognizing race and racism.
40:17And our identities around race and
40:20racism really affect how we see,
40:22talk, deal,
40:24or avoid the way we approach racism.
40:27So if you don't know this body of work,
40:30I would strongly encourage you to
40:34familiarize yourself with this.
40:35Some of the work of Janet Helms,
40:38Bill Cross, Rob Sellers,
40:39that really begins to talk about how,
40:43you know,
40:43people of color have different ways of
40:46approaching race and racism and where
40:49you are on that gives you a sense of
40:52your own ability to actually discuss this.
40:55Yeah,
40:55we have focused a lot on microaggressions.
40:59And you know,
40:59one of the questions I would have for folks
41:02is what do you think about these experiences?
41:04Do you see them as innocuous?
41:06Do you see these experiences
41:08as being harmful?
41:10What's your own experience
41:11and attitudes on that?
41:13Recognizing that our patients may not just be
41:17reacting to one time being ignored in line,
41:20but a lifetime of being ignored,
41:22right?
41:23So that these microaggressions
41:25aren't just a single incident,
41:27but it's a cumulation of
41:29incidences all over time.
41:34The other question I would
41:35have for my colleagues too,
41:36is recognizing your own power.
41:40You know, our culture places a great taboo.
41:44I'm talking about race in almost any space.
41:48We are constitutionally
41:49challenged by this task,
41:52that this is a very challenging piece.
41:54And particularly, you know,
41:55as a person of color,
41:57we are taught not to talk
42:00about race in many spaces,
42:02particularly in white spaces,
42:04and sometimes even within our own
42:07communities, certainly within
42:08the Asian American community,
42:10I have seen that quite a bit,
42:12and it has been my experience as well.
42:15And so it's very difficult for our patients,
42:17our students,
42:18our clients to even raise racial issues and
42:21even acknowledge that race is in the room.
42:25And some of the literature my,
42:26my colleague Doris Chang down in,
42:28in New York has found that often times
42:32people of color will literally in therapy,
42:35navigate and minimize discussions of race
42:39in working with a white therapist, right?
42:42Why?
42:42Because we have this taboo,
42:44we can't bring it up, right?
42:46And so recognize then that as
42:49healthcare providers, as healers,
42:51we walk into the situations where
42:54there's already a cultural norm
42:56around not talking about it.
42:58And that as figures of authority,
43:00we hold some power as to whether or not
43:03we allow race and racism into the room.
43:06Your client's not gonna raise it.
43:08We've been taught never to
43:10race it because it's a risk,
43:12right?
43:12And and so one of the things that many
43:17marginalized individuals are really
43:20very good at and very keen at is
43:24trying to figure out, do you get it?
43:27Do I have to explain this to you?
43:30Do I have to tell you my story?
43:33Do I have to justify myself?
43:35Do you get this?
43:36And trying to figure out what is
43:39the racial risk in the room, right?
43:41And trying to figure it out,
43:42is this somebody I can trust?
43:45Is this somebody who gets it right?
43:48And this is helpful because this
43:51is critical because the answer
43:53to that question is the pivot
43:56upon which racial healing really,
44:00really turns right.
44:03If the patient is not feeling comfortable,
44:07if the patient doesn't feel like you
44:10have an understanding of what is going on,
44:14as Doctor Chang and her colleagues have
44:17found, they're not gonna bring it up at all.
44:20They'll find a way around it,
44:22right?
44:22And so,
44:23you know,
44:24I put here your practice because
44:27it's really a call and a question
44:30to look in the mirror to see,
44:34you know, what do you need to
44:35know or learn about racism?
44:37What don't you know,
44:38especially in this case
44:40around Asian Americans,
44:43are you comfortable talking
44:45about race and racism?
44:46What have you talked about?
44:47What are you uncomfortable at?
44:49How do you even bring Ed,
44:50race and racism into the room?
44:53You know, what have you shared and
44:55what are you willing to share or
44:57what's awkward for you to share
44:58about race and racism or about Asian
45:01Americans and their experiences?
45:03Can you have a discussion about
45:06race and racism with somebody
45:09from another racial community?
45:12What's challenging about that or
45:14what's easy about that, you know?
45:17What are your thoughts on the
45:20power that you bring into the
45:23room to raise race and racism
45:25in your trainings and seminars?
45:28What activities do you have
45:30around race and racism?
45:32What are the readings that you have?
45:35Who are the speakers
45:36that you have brought on?
45:37Is it just me or are there others?
45:41You know,
45:41what are the spaces that you have created
45:44as an institution for your students,
45:47for your patients, for your colleagues,
45:50for your staff to talk about race and racism,
45:56whether it's for Asians or Asian
45:58Americans or other groups?
45:59How do you celebrate,
46:03Honor different marginalized communities
46:05within your institution, right?
46:08And even more personally,
46:10look behind you in your office or you know,
46:14in your home when you get on screen,
46:17what decorations, pictures,
46:20artwork, mementos, books,
46:23line or office and how does that
46:26communicate anything about race and racism?
46:29As you can see,
46:30you know,
46:31there's a lot of questions to ask,
46:33but I ask it just to give you begin
46:35to think about this because these are
46:39the questions that you're and the
46:41answers to these questions are exactly,
46:46are exactly the answers that
46:48your patient is looking for.
46:50They are looking around behind you
46:52in your office to see what's up on
46:55that wall 'cause they're trying to
46:57figure out does this person get it?
46:59Does this person understand?
47:01Do they have, is this somebody I could
47:04trust to bring this up into the room?
47:06They're never gonna ask.
47:07I have yet to see a client ask that directly,
47:11and if they do, more power to them.
47:14But given the taboos surrounded it,
47:17more likely than not,
47:18it'll be a hard question to ask.
47:19So these questions, you know,
47:21it's not just about what the patient is
47:24coming in and what they're presenting.
47:26It's also about our ability to create
47:29an environment that allows the patient
47:32to present some of these issues, right?
47:35It's our ability to create that environment.
47:41So what happens in treatment?
47:45One of the first things is psychoeducation
47:48and just giving things a name.
47:50I remember a book I read in grad school by
47:56Tori called Witch Doctors and Psychiatrists,
48:00and one of the things that he
48:05really struck me as he examined
48:07healing traditions from psychiatry,
48:10psychology to shamanism to Kuranderos,
48:14one of the common features of
48:17healing traditions was naming, right?
48:20You name something, identify something,
48:23and when you name it, that's the one
48:25of the first steps of healing, right?
48:27And I have taken that with me and
48:30kind of held to that in many ways.
48:32And particularly when it comes to
48:34Asian Americans and racial trauma,
48:35I think it's particularly poignant and
48:39important intervention to name something,
48:42right?
48:42Because a name gives you something to
48:44wrestle with. A name gives you validation.
48:47A name makes it exist in ways
48:50that it doesn't before, right?
48:52And particularly for Asian Americans,
48:55this is really important to remember
48:57because even though Asian Americans have
48:59been in this country for hundreds of years,
49:01right,
49:05the vast majority of Asian Americans,
49:07about 60% of Asian Americans in this country
49:11are actually first generation immigrants,
49:13right? So 60. And I'm an immigrant.
49:16My family's an immigrant.
49:17I I immigrated here in the early 70s and
49:21one of the things I will tell you is that
49:25racial dynamics was new to my family.
49:29The racial history of Asian Americans
49:32was entirely non existent for my family.
49:34Even though my father and mother immigrated
49:38here from the Philippines, they had no idea.
49:44They had no idea that California
49:48had Filipinos before them.
49:51You know, we came as a result of the 1965
49:53Immigration Act and that opened the doors.
49:56But they had no idea that there were
49:58other generations before them, right?
49:59So they had no idea that Watsonville,
50:04a town we had visited as I was a kid and
50:07coming up and down the California coast,
50:09was the site of the largest anti Filipino
50:13riots where several people were murdered
50:17and attacked throughout the town.
50:19I had no idea that right.
50:21So their understanding of race and racism
50:25is often times not there in many ways.
50:28So giving things a name, right,
50:31provides that concrete experience
50:34and it provides a validation.
50:38So there's a lot of teaching that goes on,
50:40which gets us to racial socialization.
50:43And this is an area of the literature
50:47that really talks about to what extent
50:50do parents and families actually teach
50:52their kids anything about race and racism.
50:55And what we're finding is that this is
50:57different across different racial groups,
50:58and particularly within Asian Americans.
51:01This is woefully a small part of parenting.
51:06And so in fact,
51:08there's a a study that Donna Nagata did
51:12with Japanese Americans families and
51:15their experiences around the internment.
51:18And I want to ground you here.
51:20Think about this.
51:21The Japanese American internment
51:23was probably one of the starkest,
51:25most brutal examples of institutional
51:27racism in this country, right?
51:30At least against Asian Americans.
51:31So it's very stark.
51:33It's included in so many references
51:35and texts, including this presentation.
51:38But what Doctor Nagata found in
51:40her work was that on average,
51:42families talked about this,
51:44I guess, how,
51:46how long,
51:46how often
51:4915 minutes, 15 minutes,
51:5310 to 15 minutes is all that
51:55kids ever heard about this.
51:57Now there's a lot of cultural reasons
52:00and you know, community based
52:02reasons about why that happened,
52:04but just the fact that here is an
52:08incident that has affected and was
52:11targeted at hundreds of thousands of,
52:13of individuals and discussion about it was
52:18relatively minimal attributional shifts.
52:21I think one of the important
52:23interventions that we can have is
52:26to begin to get people to understand
52:28racism as a systemic experience that
52:30is rooted in institutions and cultures.
52:34Because one of the things I have
52:36found often times is that, you know,
52:38Asian Americans, you know,
52:40feel targeted as an individual.
52:42What they don't realize is the
52:45larger systems behind them.
52:47I was working with a young
52:50woman and around this topic,
52:52and she came in one day and we
52:55were having this discussion.
52:57And she said, oh, you know, my,
52:58my mom was really interested
53:01in what we're working on,
53:03which is race and racism.
53:05And when the daughter explained
53:09this to the mom, the mom said,
53:11well, I don't,
53:12I don't know why you're studying that.
53:15Why are you interested in that?
53:18That's the price we pay for
53:20being in this country.
53:22And the one message that the mother
53:24sent to the daughter, right,
53:26is that this isn't our country.
53:31This is just what happens to us, right?
53:33And so there's a sense of agency there,
53:36right? And the daughter was thinking,
53:37you know, this is my country, right?
53:40This is, this is where I belong, right?
53:43And I deserve to be here.
53:45But the attributional shift was that,
53:47you know, this is something that happens
53:51and it's part of the fabric and there's
53:53nothing you can do with it, right?
53:57One of the common questions
53:59I get is around coping.
54:01And unfortunately,
54:01when we looked at the literature,
54:03I think there's a lot of
54:07complexities there that are make it hard
54:10to identify coping strategies, right?
54:12And you know, people ask, well,
54:14what's the best way to cope?
54:15That's a hard question to answer. Why?
54:17Because one of the things we're really
54:21come to appreciate is that, you know,
54:23the experience of racism is idiosyncratic.
54:26Like let's take one of those items.
54:28You're you're called a name or a slur, right?
54:32It's completely out of context, right?
54:35How you respond and how you cope
54:38with that depends on the context.
54:40You're called a name or a slur
54:43when you're on the playground.
54:45That's one way. 11 context.
54:47You're called a name or slur by your teacher,
54:51you're called the name or a slur by
54:54your boss, you're called the name or
54:57a slur by a stranger at the store.
55:00Each one of those things
55:02are different incidences,
55:03yet they're also the same incident, right?
55:06So when we look in the scholarship
55:09about how people can cope,
55:11it's, it's a mixed bag.
55:12And I think one of the reasons why
55:14is that it really reflects on the
55:16different context in which you're in.
55:19Same with social support.
55:21We turn to social support and
55:24in the hopes that, you know,
55:27being in spaces with people of
55:30like experiences will help and
55:32there's evidence for that.
55:33At the same time,
55:35we also see evidence that
55:36social support can be hurtful.
55:38Why is that?
55:39I think it,
55:40it's really has to do with the
55:42nature of the social support.
55:43If you're seeking support from
55:45individuals who are really don't believe
55:48that race or racism exists or that
55:50it's relevant for Asian Americans,
55:52that's not the support you need.
55:54If you are looking at it from,
55:56you know,
55:57looking for support from your mother
55:58and your father and your siblings,
56:00all of whom want to deny it or
56:02think it's not a big deal because
56:04this isn't your country,
56:06that's not the support you need.
56:08So really thinking contextually about
56:11who you're getting social support
56:12from and where you get it from.
56:15For myself,
56:15going through my own process in here,
56:18I found absolutely no support
56:20from the Asian American community.
56:22In fact,
56:23I was fairly ostracized going
56:26through this experience.
56:27And people would look at me and say,
56:29you know, why are you so angry?
56:31How come you're so militant, right?
56:33Where I found my social support
56:35really around this was within the
56:38African American community, right?
56:40And colleagues and friends there
56:41who could provide that support
56:44and understanding in ways that my
56:46immigrant community really couldn't.
56:49So again,
56:50thinking about social support
56:52with some new ones.
56:54I'm aware of the time here,
56:55so I'm gonna kind of go
56:57through this rather quickly.
56:58But the main point that I wanna
57:01share here is that if all we're
57:04doing is helping individuals cope,
57:06then all we're really doing is letting
57:09institutions and communities off the hook,
57:12right?
57:12Our job shouldn't be here to
57:15help perpetuate and collude with
57:18a dysfunctional system.
57:20As healers,
57:21we also have some ability to shape
57:24institutions ourselves and really
57:26begin to think about, you know,
57:28what is the stance of the organization,
57:32right, in terms of its willingness to learn,
57:36unlearn and relearn racism as an institution.
57:40Is it a learning organization?
57:44And in terms of margins and mainstream,
57:48really thinking about is how it is.
57:50Where is that learning centered within
57:53an organization or an institution?
57:55Is it, how is it embedded in its leadership,
57:59in its policies,
58:01in its practices, in its hiring,
58:03in its tenure and promotion processes,
58:06in its advancement process,
58:08in its continual education?
58:10How is it embedded into the institution?
58:13Right.
58:16So in the interest of time, I'll,
58:20I'll just truncate that piece of it.
58:24But what you can see here is that,
58:26you know, the need then is really to
58:29look at all aspects of an institution,
58:32because an institution and its leaders,
58:35they create the climate,
58:37they hire and support the individuals.
58:40They are the ones that sets the expectations
58:42and norms for how do you do this?
58:44And do you talk about race or do you only
58:47talk about it when an incident happens?
58:49Right? They're the ones who fund
58:52the resources that enable us to
58:54really center racial justice within
58:56all aspects of the institution.
58:58And without this,
58:59then individuals who are going
59:01through the institution are
59:02gonna find it very hard to cope.
59:04So again, if all we're doing is to
59:07help our clients and patients cope
59:09with the dysfunctional institution,
59:12then we're also allowing that
59:14institution to exist.
59:15So is this a lot I'm throwing
59:20at you as I wrap up here?
59:21Yeah, it is.
59:23It is.
59:24And you know,
59:25in the in this time of chaos
59:27and that time's despair,
59:30what I'm really grounded by
59:31and what has helped me has been
59:34actually my students and our youth.
59:37And I want to show you here a
59:39clip of a rally that I had gone
59:43to here in Northern California.
59:46And hopefully the audio will come through.
59:55And I saw this drawing
59:57support and scanner for ages.
59:59I've always been pressed about
01:00:00how the earth and spaniel gets
01:00:02rated out and discrimination.
01:00:04So I first thought as an Asian
01:00:06elegant pushed on the news,
01:00:07it would be Odeon, Petrograd and Chuck.
01:00:09That's for our society.
01:00:12This is America. Why was
01:00:15the company
01:00:17now? This was a rally here in San Mateo.
01:00:22You may not have heard it very clearly.
01:00:25You can read what what Ashlyn had to say
01:00:29here, but you may not have heard it clearly.
01:00:31But what you really need
01:00:33to hear is her voice.
01:00:35And most importantly, most importantly,
01:00:38that at 13 years old,
01:00:42this young woman has a voice,
01:00:46has the courage to stand up on that bench,
01:00:50has the courage to pick up that bullhorn,
01:00:54has the courage to speak, right?
01:00:58That's what I find most inspiring.
01:01:01And what I've, what has struck me as I
01:01:04have attended many of these public events
01:01:06is that many of these things, the energy,
01:01:09the passion has come from our youth.
01:01:13So if Ashlynn and other youth like her,
01:01:16right, have the courage to pick up this
01:01:19bullhorn in front of all these cameras,
01:01:21right, we as a group of professionals
01:01:25with big fancy degrees can do no less.
01:01:29So in closing,
01:01:31I wanted to share with you,
01:01:37I've been reading this book lately
01:01:38and one of the characters shares
01:01:40this proverb about, you know,
01:01:41when's the best time to plant a tree?
01:01:44And the answer is 20 years ago.
01:01:50So the next question is, well,
01:01:52when's the next best time?
01:01:56And the answer to that is now.
01:01:59You know, when I think about where we
01:02:00are in this country and where we are
01:02:02within the Asian American community,
01:02:04it occurs to me just how far we have to go,
01:02:07how much we have yet to do,
01:02:08how much is unimagined and unfinished.
01:02:12We talk a lot about, you know,
01:02:16dismantling systems of oppression
01:02:18that actually is easy.
01:02:21I will argue what it is harder is
01:02:26building justice, creating justice.
01:02:28It's hard to picture that.
01:02:30It's easy to point at our pain.
01:02:32It's harder to build systems and communities
01:02:36that actually foster justice and healing.
01:02:39But if you're attending this, I'm assuming
01:02:42you want something better as well.
01:02:43You're wanting something
01:02:45better for your patients.
01:02:46You're wanting something
01:02:47better for your students.
01:02:49You're wanting something better
01:02:51for your institutions, right?
01:02:53And as this slide shows,
01:02:56the time to start is now.
01:02:58The people who have the power
01:03:00and the education to do this
01:03:02are already on this call.
01:03:04And the people we do this for look
01:03:07a lot like Ashlyn and that little
01:03:09girl with a bullhorn on that bench.
01:03:11And she, like others,
01:03:13needs us now and quickly.
01:03:16So with that,
01:03:17I want to thank Maria.
01:03:19I want to thank Cindy for giving
01:03:21me the space to talk.
01:03:22But hopefully we have some time to
01:03:25have an exchange and let me stop
01:03:28share so we can see each other more
01:03:31than our little pixelated faces.