Yale Psychiatry Grand Rounds: October 14, 2022

Transcript

• 00:00After you and.
• 00:03Huge thanks to you and the work that
• 00:05you're doing with Yale chat together.
• 00:08You know, I think seeing the innovative
• 00:11approaches that are coming out and
• 00:13are so desperately needed, you know,
• 00:15beyond sort of breaking beyond academia
• 00:17and directly into the community,
• 00:19it's really sort of an inspiration
• 00:20and honor to be introduced by you.
• 00:23So thank you.
• 00:23I also, there's a lot of
• 00:25information to get through today,
• 00:27but I do have to start by saying
• 00:29it's such a huge honor to be back
• 00:31here as you heard as Tom Stewart.
• 00:33Told me during my consultation at Yale
• 00:35that I'm dipped in blue and very much
• 00:38a yalie at heart through and through,
• 00:41so the only thing that would have been
• 00:43better than being invited to give these
• 00:44grand rounds would be to do so in person.
• 00:46However,
• 00:46I will be in New Haven this coming May for
• 00:49my 20th college reunion Ghost Element,
• 00:52so hopefully I will have a chance
• 00:53to see some of you in person then.
• 00:55And I also really want to really
• 00:58take some time to thank and
• 01:00acknowledge some of the incredible
• 01:02individuals within this department,
• 01:04which I hold near and dear,
• 01:06who really shaped my own pathway
• 01:08and journey into psychiatry and more
• 01:11specifically academic psychiatry
• 01:13as a medical student who graduated
• 01:14from here in 2009.
• 01:16So first, of course,
• 01:17tremendous thanks to Bob Rabah,
• 01:18who has been a trusted mentor.
• 01:21You've been advisor and now
• 01:22a friend and colleague.
• 01:24We had a very memorable dinner.
• 01:25That the AP and New Orleans this past May,
• 01:28which I think was sort of the
• 01:30origin of the today's talk.
• 01:31Also, thinking back,
• 01:32it was nice to remember some names.
• 01:34Bob Millstein, Jud Brewer,
• 01:36Paul Desan,
• 01:37Tom Stewart who were all part of my
• 01:39formative 30 year psychiatry clerkship.
• 01:41I actually published some students.
• 01:44Now I put psychiatry as my first
• 01:46rotation because I thought I didn't.
• 01:48It wasn't on my radar.
• 01:49I thought it would be a good warm
• 01:51up for clinical medicine and I never
• 01:52suspected that I would immediately
• 01:54fall in love both with the patients
• 01:56but also the staff on WS2.
• 01:58It really, you know,
• 01:59shaped my entire life and career.
• 02:01Catherine.
• 02:01Files an incredible mentor and visor
• 02:03through the Yale Medical Student and
• 02:05Psychiatric Association and all the
• 02:07support I received from Paul Kerwin,
• 02:09Dell Sledge and others.
• 02:10I think Doctor Crystal,
• 02:11you were coming in just as I was leaving,
• 02:13but I definitely remember that
• 02:15formative moments as well as outside
• 02:17of psychiatry being of students.
• 02:20Nancy Angoff,
• 02:20who I understand has since retired,
• 02:22but a lot of really,
• 02:24really important special people in my life.
• 02:26So with that, let's dive in.
• 02:29I don't have any financial
• 02:30disclosures or conflicts of interest.
• 02:31We do run this organization have mentioned,
• 02:33but it's an unpaid position.
• 02:35I don't have any other conflicts
• 02:37with the content of today.
• 02:40However,
• 02:40as with any good psychiatric presentation,
• 02:42I have many personal disclosures to make,
• 02:45and I think this type of
• 02:47work is so deeply personal.
• 02:48I myself identify as the child of
• 02:51Taiwanese parents, who themselves
• 02:52would identify as tiger parents.
• 02:55Pretty proudly actually.
• 02:56And so I'm a second generation
• 02:59person born in the US to immigrants.
• 03:02And so when I talk about this stuff,
• 03:04it just feels very natural to me because
• 03:06I feel like I experienced many of
• 03:08these cross cultural challenges myself
• 03:10growing up and just some some photos
• 03:11I found when on a trip home recently.
• 03:14So, you know, it'll probably come
• 03:17out during the presentations. Now,
• 03:19I also have to make a lot of disclaimers.
• 03:22The minute you start talking about
• 03:23any racial or cultural group,
• 03:25there is going to be a lot of
• 03:27concerns raised that are appropriate.
• 03:29What does it mean to be from Asia?
• 03:31Asia is an enormous place.
• 03:32What does even mean to be from China
• 03:34or from the US for that matter?
• 03:35So, you know,
• 03:36obviously when we're talking about
• 03:38these large sociocultural groups or
• 03:40racial groups or geographic groups,
• 03:42it it leads a lot of.
• 03:45And nuance.
• 03:46And we also certainly know that culture is
• 03:49not the same as country of origin or race.
• 03:52And unfortunately, in medicine we try
• 03:53to operationalize things in its ways.
• 03:55But clearly there's many layers
• 03:57to our personal identity.
• 03:59That being said, you know,
• 04:00I I take all that sort of.
• 04:05Nuance and ambiguity and we have to
• 04:07still do something and still have
• 04:09to try to understand what are the
• 04:11commonalities and how do we approach them.
• 04:13So today I want to talk about
• 04:15three main things.
• 04:16First,
• 04:16give you a broad overview of sort
• 04:18of the state of Asian American
• 04:19and Asian International Student
• 04:21mental health in this country.
• 04:23Then talk about the impacts
• 04:24of COVID-19 on that.
• 04:25And finally,
• 04:26share information about my own center
• 04:28as one example of an innovative approach
• 04:31for engaging this underserved population.
• 04:33As again, as you heard,
• 04:35there are other examples including
• 04:37Doctor Yunus chat together or
• 04:38Stanford's cheap power initiative,
• 04:39which are really trying to
• 04:41address these same issues, OK.
• 04:43So let's start with the case,
• 04:44since we're all,
• 04:45many of us are clinicians here.
• 04:47This was the case for my own practice.
• 04:49I would refer to Teresa, who was an
• 04:5118 year old Chinese American woman.
• 04:53She was a very accomplished person.
• 04:55She was.
• 04:56She graduated valedictorian
• 04:57of her high school.
• 04:58She, you know,
• 05:00was leader in many
• 05:02extracurricular activities.
• 05:03But she had a very rigid and
• 05:04perfectionistic thinking style,
• 05:05which made her very anxious.
• 05:07And when I met her,
• 05:08she was actually just about to start college.
• 05:11But talking to her, she says that.
• 05:13There are symptoms actually began earlier,
• 05:16as is often the case during
• 05:18her adolescence in high school.
• 05:19However,
• 05:19none of her or her family actually really
• 05:22believed in mental illness at all.
• 05:24Her parents were both scientists
• 05:25and they said we don't really
• 05:27think this is a real thing,
• 05:29so they sort of powered through it.
• 05:30And interestingly, you know,
• 05:31despite her struggles with many students,
• 05:33we would start to see a fall off
• 05:35academically as the first sign.
• 05:36But with her, she continued to have
• 05:39a stellar academic track record and
• 05:42then the summer before beginning.
• 05:44An elite university.
• 05:45Her anxiety became so paralyzing that
• 05:47she couldn't complete basic tasks.
• 05:49And when I met her, I believe, remember,
• 05:51she was basically spending all day long,
• 05:53like opening and closing new e-mail
• 05:55accounts because one of the ways that she
• 05:58coped with anxiety was to go shopping online.
• 06:00But then she couldn't sort of face the
• 06:03anxiety of having to pay some of the bills
• 06:05or deal with some of the logistics of that.
• 06:08And so she would actually like,
• 06:09close the account and start a new one.
• 06:11And she was also spending a lot
• 06:12of time just sort of online.
• 06:14Look in the web,
• 06:15things you might expect.
• 06:16And then our suicidal thoughts and her
• 06:18parents finally brought her to see someone.
• 06:21Now, that being said, you know,
• 06:23you would hope that this would be the
• 06:24beginning of a fruitful relationship,
• 06:26but actually we spent most of our
• 06:28sessions kind of hustling about what
• 06:31is mental health and what might help.
• 06:34And I take a very motivational approach.
• 06:36But I also was very concerned
• 06:38about her level of dysfunction,
• 06:40talked about medications,
• 06:41talked about psychotherapy,
• 06:42and each thing was sort of a struggle.
• 06:45Eventually, actually,
• 06:45you know, I when I met her,
• 06:47I was so alarmed that I actually
• 06:48pushed for higher level of care,
• 06:49which they declined.
• 06:50She ended up going to school,
• 06:53but about a couple months into her
• 06:54first semester had an asthma attack
• 06:56that brought her to the medical Student
• 06:58Health service and from there disclosed
• 07:00suicidal thoughts and was hospitalized.
• 07:02So it really was a classic case of
• 07:04really deferred care, tons of stigma,
• 07:07lack of education about mental
• 07:09health and sort of treatment delay.
• 07:12So with that backdrop,
• 07:13I can say that,
• 07:14you know,
• 07:14part of the reason we should all be
• 07:16thinking about this is that while the
• 07:18Asian American population is only
• 07:20just under 6% of the population now,
• 07:22it's actually one of the fastest growing,
• 07:24the fastest growing racial group in the US,
• 07:26recently surpassing Hispanics
• 07:27and the fastest growing group.
• 07:29And by just, I think it's by 2050 or so,
• 07:362055,
• 07:36they're expected to be close to 10 percent,
• 07:388 / 8% of the populations and most of that.
• 07:41Growth is fueled by immigration
• 07:43more so than childbirth,
• 07:45and so it speaks to the ongoing relevance
• 07:47of understanding traditional cultural
• 07:48values that folks are bringing with
• 07:50them when they come to this country.
• 07:52Now,
• 07:52I've titled my talk breaking
• 07:53silences in the model minority,
• 07:55and the model minority term is
• 07:57itself somewhat controversial,
• 07:58but I'm using it because many
• 07:59people think of Asians in that way,
• 08:01and according to Wikipedia,
• 08:02a model minority is any demographic
• 08:04group whose members are perceived
• 08:06to achieve a higher degree
• 08:08of success, whether financially or
• 08:10educationally, than the population.
• 08:12Average and there's been other
• 08:13groups obviously that have fit the
• 08:15stereotype and I've listed some of the
• 08:18stereotypical characteristics of this
• 08:19group including importantly the last
• 08:20one which is sort of not speaking up.
• 08:23Got that much kind of keeping your
• 08:24head down and and trying to get
• 08:26ahead and and again many of these
• 08:28qualities are actually a good thing.
• 08:29You know I don't want to say that
• 08:32you know these these are things to be
• 08:34ashamed of but I think this is sort of
• 08:37a broad brush stereotype and as the
• 08:40writers Monday DJ has reminded us.
• 08:42The danger of a single story and
• 08:45the stereotypes.
• 08:45It's not that necessarily we're
• 08:47seeing stereotypes are untrue,
• 08:49but that they are incomplete.
• 08:50And if you haven't seen her things,
• 08:52fantastic Ted talk I'd recommended
• 08:54about the dangers of a single story.
• 08:56And so that's indeed the case,
• 08:58I think with any stereotype of a group
• 09:01when we think about the problems
• 09:03of the model minority stereotype
• 09:05on a large big picture scale.
• 09:07First of all, as I said,
• 09:08Asia is a huge place.
• 09:09And so if you think that all
• 09:11Asians are successful,
• 09:12it really obscures problems.
• 09:14For instance,
• 09:15high rates of uninsurance among Korean
• 09:17immigrants and in in California
• 09:19are very high rates of sort of
• 09:21metabolic illnesses and low rates
• 09:23of treatment and medical treatment
• 09:26engagement in Southeast Asian.
• 09:27Populations, etcetera.
• 09:28So we're really not all one group.
• 09:30But this stereotype misleads
• 09:32policymakers essentially to overlook
• 09:34the issues that are relevant that
• 09:36we're still struggling from and also,
• 09:38very importantly sets up a divisive
• 09:40contrast with other so-called
• 09:42not model minorities.
• 09:43What does it mean to be a model minority?
• 09:45There has to be someone who's not doing well.
• 09:47And I'll talk more about that for
• 09:50that particular form of racial
• 09:51wedging later in the talk.
• 09:53And for students in particular,
• 09:54we hear over and over again,
• 09:55you know, you think, oh, this is a,
• 09:57a seemingly.
• 09:58Positive stereotype,
• 09:58but it actually originally shapes these
• 10:01students identities and expected performance.
• 10:02So they sort of feel like if I'm
• 10:04not good at math,
• 10:04I'm not getting great good grades,
• 10:06there's something wrong with me,
• 10:08and that message is fed forward repeatedly,
• 10:10even if that's not something
• 10:12they're interested in also.
• 10:15Makes it even harder to seek help
• 10:17than it already might be at baseline.
• 10:18You know,
• 10:19if you're supposed to be doing well,
• 10:20then how can you be the one
• 10:22person who's asking for help?
• 10:24And then, of course, increase the anxiety.
• 10:26And we also know from sort of the
• 10:28national media that this sort of myth
• 10:30of the model minority is starting
• 10:32to be punctured and there's more and
• 10:34more awareness in mainstream media
• 10:36about the pressures on especially
• 10:38Asian American young people.
• 10:40So when we look at the disparities,
• 10:41one of the biggest ones are in
• 10:43treatment engagements.
• 10:44In almost every study ever done,
• 10:45Asian Americans are about two
• 10:47to three times less likely
• 10:48to seek mental health treatment
• 10:49than the rest of the population.
• 10:50And even when they do receive treatment,
• 10:52they're more likely to rate the
• 10:54service has received as unhelpful.
• 10:56This is some research that came
• 10:57out of our own group up in Boston.
• 10:59We were analyzing the American
• 11:01College Health Association's
• 11:02National College Health assessment.
• 11:04It's an annual survey given to
• 11:06universities around the country.
• 11:07And so this particular survey
• 11:09had 67,000 responses from
• 11:12undergraduates at 108 colleges.
• 11:13And what you're looking at here in
• 11:15this big table are odds ratios of
• 11:18various self reported mental health
• 11:19related symptoms and diagnosis.
• 11:21I'll just draw your attention to
• 11:23the Asian Pacific Islander column
• 11:24and if you look at the rates.
• 11:26This is, you know, them saying,
• 11:27I have been diagnosed with any
• 11:29of these illnesses, depression,
• 11:30anxiety, et cetera.
• 11:31And you can see their rates
• 11:32of diagnosis are very low.
• 11:34It's about they're about half or even
• 11:36some often less than half as likely
• 11:39to receive a mental health diagnosis.
• 11:41And yet if you look at their
• 11:42rates of attempting suicide,
• 11:43it's nearly 40% elevated
• 11:45compared to the reference group,
• 11:46which is white students.
• 11:48And so obviously for me as a clinician,
• 11:50this is very alarming and it
• 11:52matches my clinical experience,
• 11:53which is that this is a group
• 11:54that's just skating under the radar.
• 11:55They're not getting diagnosed.
• 11:57And yet they're at incredibly high risk.
• 11:59And yet no one is seeing it or
• 12:01talking about it except those
• 12:02of us who did the clinical work.
• 12:03When you think about research as
• 12:05well there there's been a lot of
• 12:06attention that's come to this.
• 12:07Over the past couple of years,
• 12:09in the wake of the pandemic and anti
• 12:11Asian racism that we've experienced,
• 12:13agents have been described as the most
• 12:15understudied racial or ethnic group
• 12:17in the peer reviewed literature with
• 12:19significant underfunding by the NIH.
• 12:21Compared to other groups,
• 12:22often when you look at research studies,
• 12:24Asians are not included at all as a category.
• 12:27They're sort of excluded from
• 12:29the research to segregation.
• 12:31And even when agents are included,
• 12:33it's certainly not disaggregated
• 12:34further since we're such a small
• 12:36pot part of the population.
• 12:37So there's been a lot of push to sort
• 12:39of say rather than just saying all
• 12:41Asians or not even including Asians,
• 12:43we really need to start disaggregating.
• 12:46Now,
• 12:46when you think about why are
• 12:47people not coming to treatment
• 12:49or getting into treatment,
• 12:50you can sort of divide it into
• 12:52structural and cultural barriers.
• 12:53And I'm starting with structural because I
• 12:55think we often lead to their cultural ones,
• 12:57and I do that myself.
• 12:58And those are important.
• 12:59But we shouldn't forget that the structural
• 13:01barriers are very large for all of us.
• 13:04How hard is it to get a therapist?
• 13:06You know,
• 13:07this is obviously national discourse
• 13:08right now in terms of cost,
• 13:10transportation,
• 13:10access,
• 13:11as well as the language mismatch as well.
• 13:14There's a a fair amount of
• 13:15literature to suggest that
• 13:16mental health interventions are poorly.
• 13:18Accepted for their birth patients and
• 13:20that culturally adapted interventions
• 13:21tend to be far more effective.
• 13:23There is a literature on that.
• 13:24So sipoc patients.
• 13:25There is also evidence of bias within
• 13:28our diagnostic systems and sort of how
• 13:31we label and treat various experiences.
• 13:34And when we're limited by time,
• 13:35it can be hard to delve in and
• 13:37actually get to an appropriate
• 13:39diagnosis as well as of course this
• 13:41sort of model minority thing that's
• 13:43further applied externally to minimize
• 13:45one's own concerns culturally.
• 13:48Again, these are very important as well,
• 13:50often a belief that these types of
• 13:52things are not illnesses at all,
• 13:53but actually weaknesses of personalities
• 13:56that can be corrected by more hard work.
• 14:00Some people have suggested that
• 14:01in the West we have sort of a
• 14:03cultural tradition of catharsis,
• 14:04meaning that you should just
• 14:06get it out there and, you know,
• 14:07feel your feelings and experience in
• 14:09them and then you'll feel better after.
• 14:11Whereas in many Asian cultural context
• 14:14it's actually seen as a burden to display
• 14:16your emotions and you wouldn't want to be.
• 14:19Putting that on someone else,
• 14:20so more of an inhibition culture.
• 14:23Also, if anyone spent time in
• 14:26Asian psychiatric content context,
• 14:27you know that traditionally
• 14:29psychiatry has low status.
• 14:31It's sometimes not even seen
• 14:33as a fully medical specialty,
• 14:35but more of a social services specialty.
• 14:37And often that stigma is encoded
• 14:40structurally in terms of where people
• 14:43get their treatment in these very,
• 14:46very large facilities that are sort of
• 14:49stigmatized and kept out of the mainstream.
• 14:52Also,
• 14:52specifically for Asian families,
• 14:54one thing I see a lot is just a
• 14:56total breakdown in communication.
• 14:57And this is a very tragic because
• 15:00parents are obviously should,
• 15:01can and should be a huge source
• 15:02of support to their kids.
• 15:03But both for language and cultural reasons,
• 15:06between sort of Americanized kids
• 15:08growing up in a Western cultural context
• 15:11versus their more traditional parents,
• 15:13they're the huge breakdown.
• 15:14And then of course they mean shame,
• 15:16which is under a lot of this,
• 15:17and I just wanted to take a moment to
• 15:19drill down further on culture and stigma.
• 15:22In Chinese culture, for instance,
• 15:24mental illness is highly highly stigmatized,
• 15:26and the term for it is almost always
• 15:29just equated directly with psychosis.
• 15:31So if you're mentally ill,
• 15:32you're symptomatic,
• 15:33and this has implications for
• 15:35marriage and kinship,
• 15:37such that if my brother or sister,
• 15:39for instance.
• 15:39Were diagnosed with schizophrenia and
• 15:41that information were to come out.
• 15:43It would be very difficult,
• 15:44if not impossible for me to get married.
• 15:46And people like Larry Yang,
• 15:49psychologists who have studied this,
• 15:50the embodiment of stigma in Chinese society,
• 15:52have described sort of the social
• 15:54death that occurs for the entire
• 15:56family that's painted with this brush.
• 15:59Arthur Kleinman,
• 15:59who many of you know,
• 16:01anthropologist,
• 16:01psychiatrist,
• 16:02has done a lot of work on stigma
• 16:05in China about mental health.
• 16:07It has described the use of the
• 16:09term neurasthenia,
• 16:10literally weak nerves.
• 16:11The Chinese translation of weakened nerves,
• 16:14which became, it was actually an old,
• 16:16I think Continental psychoanalytic
• 16:18concept but gain popularity in China.
• 16:22So that people would actually prefer to use
• 16:24this term to describe a range of symptoms,
• 16:27things like low appetite,
• 16:28poor concentration and low energy, etcetera.
• 16:30That many of us in the West would
• 16:32start to wonder is this sort of a mild
• 16:34to moderate anxiety or depression,
• 16:36but over there, you know,
• 16:37much preferred to be a neurological illness
• 16:39that weakened nerves with corresponding.
• 16:41These physical treatments like cupping or
• 16:44acupuncture or herbs and really avoiding
• 16:47the psychological component altogether.
• 16:49And author Clinton has written extensively
• 16:51about sort of the idea of these illness
• 16:54metaphors or differences of symptom emphasis.
• 16:57It's not that Chinese people don't experience
• 17:00low mood or depression or tearfulness,
• 17:02but it's just not something that's going
• 17:04to gain you a lot of traction or benefit
• 17:07within a Chinese cultural context.
• 17:08Certainly fills with more in the surgical.
• 17:11Furthermore, as I already mentioned,
• 17:13the idea of kind of stigma and
• 17:15shame being embodied,
• 17:16this concept is sort of core.
• 17:19The way Chinese society almost is,
• 17:21is organized the idea of face or the
• 17:24end for those who speak Chinese.
• 17:26And I mentioned the social death.
• 17:28So the idea is that all of us have
• 17:30face and can gain face or lose face.
• 17:32And face is something like the individual,
• 17:34but also for your family.
• 17:35And just to illustrate the
• 17:37foundational importance of face,
• 17:38I have this quote from the
• 17:40Confucian scholar Mencius,
• 17:41who said men cannot live without shame.
• 17:43A sense of shame is the
• 17:45beginning of integrity.
• 17:45And so whereas I think in the West often we
• 17:47think of shame in sort of a negative light.
• 17:49Like something that's unuseful
• 17:50emotion that we should get rid of.
• 17:53In fact,
• 17:53I think in sort of traditional,
• 17:55at least Chinese society or
• 17:57Confucian value system,
• 17:58this is obviously like
• 18:00sort of a helpful thing.
• 18:01We have these emotions to kind of prevent us
• 18:04from doing things that are wrong or improper.
• 18:06And I think there's this idea
• 18:07that if you don't have shame,
• 18:09you're not like a fully engaged
• 18:11member of society.
• 18:12You're not someone who has matured
• 18:15in that way to be able to gain
• 18:17the privileges of being a part of.
• 18:19With society.
• 18:22Those who have studied the so-called
• 18:24self-conscious regulatory motions like
• 18:26shame and guilds have found that shame
• 18:28seems to be more linked to suicide,
• 18:30more associated with suicide,
• 18:31which I found to be an interesting concept.
• 18:33The idea being that you know,
• 18:34whereas guilt,
• 18:35there's these ideas that guilt is
• 18:37more common in the West and shame
• 18:39is more common in sort of Eastern
• 18:40Asian cultural context.
• 18:42That guilt is more individually act focused.
• 18:45It's about something you did or didn't do,
• 18:47where shame is more totalizing.
• 18:49It's about who you are as a person
• 18:50and so leads to more.
• 18:51Absolute ways of understanding oneself.
• 18:54And along with some colleagues
• 18:56again in Boston,
• 18:57I did some research into sort of the socio
• 19:00cultural and historical context of the role
• 19:03and the treatment of suicide and you know,
• 19:06the the W 1st of the East and
• 19:09the West coming from having more
• 19:12sort of Christian influences.
• 19:14At an early age, actually early period,
• 19:17stigmatizing suicides as sort of immoral,
• 19:22morally impermissible,
• 19:22and that then got encoded as
• 19:25from sin to crime to illness.
• 19:27So nowadays we think of suicide as
• 19:29almost always mentally illness related.
• 19:31Whereas when folks have done psychological
• 19:33autopsies in Asian cultural context
• 19:35in China and India and South Korea,
• 19:38they find that there may be more
• 19:41room for suicide as more of an act,
• 19:43more of a conscious deliberate.
• 19:44Act for protests or for other
• 19:48morally permissible reasons.
• 19:50Anyway, that's going down tangent.
• 19:51We also know that culture really shapes our
• 19:54illness beliefs and treatment preferences.
• 19:56So when we were interviewing Chinese
• 19:59immigrants who presented with diagnosis,
• 20:02actually a mini verified
• 20:04diagnosis of depression,
• 20:06what we found was that they would
• 20:08almost never have depression
• 20:09as their chief complaint.
• 20:10This is in a primary care setting so they
• 20:12weren't coming to see if the Christ,
• 20:14but they were diagnosed with depression.
• 20:15And then they were, you know,
• 20:17asked what was the main thing
• 20:19that brought them in.
• 20:19It was not depressed mood.
• 20:21However, they would endorse
• 20:22it if you directly asked them.
• 20:24So again,
• 20:24it's not the case that people
• 20:25are not feeling these feelings.
• 20:27It's just that that's not the main
• 20:28thing they emphasize.
• 20:29And it was.
• 20:30They were very likely to attribute
• 20:32the cause of their symptoms to some
• 20:35sort of interpersonal stressor
• 20:36within the family or within their
• 20:39close kinship networks.
• 20:40Interestingly,
• 20:40this was a sort of repetition of
• 20:42a study that had been done about
• 20:4410 years prior and.
• 20:46What we found in that prior study
• 20:47was that there was a very low
• 20:49acceptance of a biomedical model
• 20:51of depression and yet so in this
• 20:53more recent study with the higher
• 20:55acceptance of that model,
• 20:56paradoxically these patients
• 20:58also endorsed a higher degree of
• 21:00stigma against those symptoms.
• 21:02So it's interesting to think about how
• 21:05medicalization may actually backfire
• 21:07on inadvertently within the population.
• 21:09So again,
• 21:09all these things were things that I
• 21:11had found based on my own clinical
• 21:13experiences having rotated at South
• 21:15Coast Community Health Center as
• 21:17a resident and then also working
• 21:19there briefly after residency.
• 21:20And what we found,
• 21:22what I heard from patients is,
• 21:23you know,
• 21:24when you think about the main tools
• 21:25that I was being trained in as a
• 21:28psychiatry resident, what I was selling,
• 21:29they didn't want to buy, put it that way.
• 21:30So if you want to talk about psychotherapy,
• 21:33but the main thing you hear is,
• 21:34you know, basically you shouldn't
• 21:36be sharing family secrets or ugliness.
• 21:38In public.
• 21:39And so the idea of talking,
• 21:41I remember my aunt in Taiwan
• 21:43who is an ophthalmologist,
• 21:44the physician herself said,
• 21:45you know,
• 21:45I just can't understand why
• 21:46you would ever talk to
• 21:47a stranger about your problems.
• 21:48It was just sort of.
• 21:50Unimaginable to her.
• 21:51And in terms of medications,
• 21:53this was really not preferred at all.
• 21:56Any chronic medication was sort of dismissed.
• 22:00Too many side effects,
• 22:01potentially addictive,
• 22:02especially anything that
• 22:04might influence sleep.
• 22:05This is seen as more of like a short
• 22:07term thing that you would use to
• 22:09eradicate an acute symptom as opposed
• 22:10to something you take every day.
• 22:12And by the way,
• 22:13this also applied to other
• 22:14chronic medications like for
• 22:15diabetes or hypertension.
• 22:16It wasn't just for psychiatric conditions,
• 22:19but you can imagine given the stigma.
• 22:21All the more so why would you
• 22:22take something every day for this?
• 22:23So that one without.
• 22:24And then group therapy where you
• 22:25can just forget about the idea of
• 22:26talking with a group of people
• 22:28who might be your peers in the
• 22:29community and sharing your secrets.
• 22:31So I wouldn't sort of, you know, flexed.
• 22:33I was like, you know,
• 22:34here I am trying,
• 22:35you know,
• 22:35drawn to this field partly through
• 22:37personal reasons and looking at the
• 22:39struggles of my own family and community.
• 22:42And nothing that I'm being trained
• 22:43in is actually going to help.
• 22:45And so as I mentioned,
• 22:47when we what we see clinically is
• 22:49often a great deal of treatment delay,
• 22:52they're often in crisis when
• 22:53they finally do prevent and even
• 22:55when they are here they're very
• 22:57difficult to engage because you
• 22:58know sort of what I think that.
• 23:00They need or want is not what they
• 23:02want or what the way they view it.
• 23:04So it's very hard also to find anyone
• 23:06who specifically treats this population,
• 23:08especially through insurance.
• 23:09And often there's a mismatch
• 23:11in treatment goal.
• 23:12So even if the parent is bringing
• 23:14their child to treatment,
• 23:15let's say they have a college
• 23:17student that the parent is helping
• 23:19to pay for treatment.
• 23:20You know that the parent views
• 23:21the purpose of the treatment very
• 23:23differently than perhaps eyes.
• 23:25The therapist would sort of
• 23:26more like this person is lazy.
• 23:29I think you need to help.
• 23:30Work harder and realize the opportunities
• 23:32they're squandering as opposed to,
• 23:33oh,
• 23:34they have a mental health condition that
• 23:36we want you to help them get better from.
• 23:39So there's not enough time to
• 23:41go through all the psychological
• 23:42challenges that are presented here.
• 23:45I will just focus on one or maybe 2,
• 23:48the separation from parents
• 23:49and the culture clash.
• 23:50And I'm going to illustrate that
• 23:52actually through a couple of things.
• 23:53Well, first through just this,
• 23:55a quote from maybe a psychological text.
• 23:59The idea that in the traditional
• 24:02Asian family hierarchy there's a huge
• 24:04emphasis of course on the the role
• 24:07of everyone's role within the hierarchy.
• 24:10In this traditional model,
• 24:11parents are the law and the children are
• 24:13expected to sort of follow that and it's,
• 24:16it's sort of stereotyped,
• 24:17I think in the West as sort
• 24:19of a very autocratic system.
• 24:21It comes from a Confucian sort
• 24:25of notion of these sort of five
• 24:28core relationships,
• 24:29which as you can see are
• 24:31somewhat hierarchical.
• 24:31They are, they are vertical and
• 24:33these are the relationships that
• 24:35would order a well functioning
• 24:37society between ruler and subject,
• 24:40father and son. Etcetera.
• 24:41One thing that many people might notice is
• 24:44that there's only one woman on this image.
• 24:47It's the wife, and she's in sort of the
• 24:49subservient position to the husband.
• 24:51Now, that being said,
• 24:52to be fair to Confucius, you know,
• 24:53this is an extreme version.
• 24:55I think in reality the idea of this
• 24:58is that there are mutual obligations.
• 25:00It's not just that there is
• 25:03a hierarchical relationship,
• 25:04but also that, let's say,
• 25:05the ruler also has obligations
• 25:07to the subject to be benevolent.
• 25:11To be just and that sort of thing
• 25:13it's it's it's a two way St.
• 25:15But the other thing to notice is
• 25:17that three of the relationships
• 25:18are within the family structure.
• 25:20So this is where some of these
• 25:22ideas come from.
• 25:22And again,
• 25:23I think in the ideal version of
• 25:25a Confucian relationship, yes,
• 25:27the parents would define the law
• 25:29and they would sort of advise this
• 25:32the child on what is their role,
• 25:34but they would also have a lot
• 25:37of duties in the same way,
• 25:39to be benevolent,
• 25:39to be thoughtful towards their child.
• 25:42But I'll try to illustrate this
• 25:44more concretely through a clip.
• 25:46From the movie crazy rich Asian.
• 25:47I don't know if anyone seen that,
• 25:48but I actually thought there
• 25:50were a lot of great moments that
• 25:52captured a lot of the psychological
• 25:54conflicts that are are patients who.
• 25:56So I'm just going to pay you the
• 25:58scene where the American born Rachel
• 26:01Chu is meeting her boyfriend,
• 26:03Nick's mother,
• 26:04Eleanor Young,
• 26:04who's played by Michelle Yeoh
• 26:07for the first time in their
• 26:09very fancy Singaporean mansion.
• 26:11So this is their first meeting
• 26:12with the mother-in-law.
• 26:15My name?
• 26:18Sometimes on the arm.
• 26:23Mom.
• 26:28You need a haircut so uncouth and
• 26:30you look tired from your trip.
• 26:32I'm going to ask the cook to make
• 26:34you some herbal soup and the guy.
• 26:37I'll send it to the hotel later.
• 26:40Is Rachel chew?
• 26:41Ohh my gosh, I I'm so happy to meet you Mr.
• 26:44Young or Auntie, right?
• 26:48I'm just learning the lingo.
• 26:50I'm very glad to finally meet you too.
• 26:52And I'm sorry Nick's father couldn't be here.
• 26:55He was called to business in Shanghai.
• 26:58Judy calls bad answers, as they should be.
• 27:02Nick tells me you're a professor, too.
• 27:04What do you teach? I teach economics.
• 27:08Youngest faculty member.
• 27:11O'clock or complaining.
• 27:14So economics sounds challenging.
• 27:16Are your parents academics as well?
• 27:19No.
• 27:19Well, my dad actually died before I was born,
• 27:22and my mom didn't even go to college.
• 27:24She actually hardly spoke any English
• 27:26when she immigrated to the United States.
• 27:28But she works really hard and she's studied
• 27:31and she earned her real estate license
• 27:33while she was waiting tables to support us.
• 27:35Now she likes to say that she's
• 27:37flushing top real estate broker,
• 27:39salt made woman.
• 27:41She must be so proud of you.
• 27:45Well,
• 27:46she knows that I'm passionate about what
• 27:48I do and she's always wanted that for me.
• 27:51Pursuing one's passion.
• 27:53How American?
• 27:55Well, your mother's very open minded.
• 27:57Not like you, where parents are obsessed
• 28:01with shaping the life of their children.
• 28:04Jennifer. Go ahead.
• 28:07I'll be out in a minute, Rachel.
• 28:09Thanks. Lovely meeting you.
• 28:11Thank you.
• 28:11You too.
• 28:14OK, she hates me. She takes a little
• 28:17minute, so warm up, but I'll get there.
• 28:20All right. So if you have more time I would
• 28:22ask you what you all saw in that scene.
• 28:23But I just love that line pursuing
• 28:26one's passion how American because
• 28:28you can sort of you hear all the pride
• 28:30and and Rachel voice and it's a very
• 28:32American story sort of self-made person,
• 28:34but you hear in the mothers.
• 28:38Description Kind of when duty calls,
• 28:41we answer and that's sort of the
• 28:43more important cultural value.
• 28:44So there is that clash that learns all the
• 28:48time clinically kind of I want to do this,
• 28:50they want me to do that.
• 28:51So and the very basic level may
• 28:54be boiled down to sort of other
• 28:56orientation versus self orientation.
• 28:58Some folks who have been studying
• 28:59this as it relates to mental health,
• 29:01I just want to uplift the work of Chris
• 29:03Tom at the BU School of Social Work.
• 29:06She's done a lot of qualitative research
• 29:08looking at young Asian American women
• 29:11who have extremely elevated rates of
• 29:13self harm and suicidal behaviors,
• 29:15very at risk group.
• 29:17And so she was looking at young Chinese,
• 29:20Korean and Vietnamese,
• 29:21identifying women in Boston and
• 29:24performing qualitative analysis
• 29:26of people who have these.
• 29:28And curious and suicidal thoughts and
• 29:31behaviors and what she came up with was
• 29:33this sort of idea of a fractured identity,
• 29:35one framework for
• 29:36understanding why this happens.
• 29:38And you can see sort of at the core,
• 29:40she identified what she has
• 29:42termed disempowering parenting,
• 29:44which leads to this kind of double bind of
• 29:47low self worth and a fractured identity.
• 29:49And then problematic behaviors.
• 29:51And the parenting she discovered
• 29:53was sort of abusive, burdening,
• 29:55culturally disjointed, etcetera.
• 29:56You can read that.
• 29:58She actually did a follow-up
• 29:59study later trying to interview
• 30:01the parents of those young women,
• 30:02and unsurprisingly,
• 30:03leads many of those parents had
• 30:06their own mental health issues that
• 30:09were being passed along head trauma.
• 30:12Substance use, etcetera.
• 30:13So it's not a surprise to those of us
• 30:16who are thinking intergenerationally.
• 30:18I'm going to give you just
• 30:20another example from my practice.
• 30:22Pamela was a 45 year old woman,
• 30:25daughter of Chinese immigrants,
• 30:26very successful professionally
• 30:27and had a high paying job.
• 30:30Her younger sister had referred her
• 30:32to therapy and having been through her
• 30:34own therapy for feeling quote UN quote,
• 30:36stuck and unmotivated.
• 30:37When I met her she was living at
• 30:39home with her parents who are in
• 30:41their 80s and that was the source
• 30:43of our entire treatment.
• 30:45They were happy about how
• 30:46successful she had been with her.
• 30:48Rear.
• 30:48But they were also really,
• 30:50really, really harshly critical
• 30:51of everyone she'd ever dated.
• 30:53And there were a lot of personality issues,
• 30:55especially with the mother in this situation.
• 30:57And yet at the same time,
• 30:58they kind of blamed her for being single.
• 31:00So they would criticize whoever she
• 31:02brought home, but then also sort of say,
• 31:04why aren't you married yet?
• 31:05Why don't you have kids despite
• 31:08this conflict?
• 31:08So she was really,
• 31:09really conflicted about this, she said.
• 31:13I think that if I were to leave,
• 31:14it would be much better for me,
• 31:16but I also think it would kill them.
• 31:18She actually really thought that.
• 31:19You know, her mother would
• 31:21die if she left the house.
• 31:22And so her symptoms were essentially
• 31:24experienced with rageful thoughts
• 31:26towards her father specifically,
• 31:27and then chronic, passive suicidal ideation.
• 31:30This case has really stuck with me because,
• 31:33you know, in our work together,
• 31:34she did start to date a little bit.
• 31:36She did.
• 31:37She had actually purchased a home
• 31:39nearby that she thought that she
• 31:41could maybe live in and come
• 31:43back to the house frequently.
• 31:45But then she's like sort of abruptly dropped
• 31:47out of treatment and I still wonder.
• 31:49You know what's going on with
• 31:50her and what happened.
• 31:53Just a few slides briefly about
• 31:55international student mental health.
• 31:57You know most of them come from
• 31:59China and India these days.
• 32:00This is a real shift.
• 32:01It used to not be mostly from China.
• 32:03And so we're seeing those
• 32:05issues show up on campus.
• 32:07There's been some mainstream
• 32:08media coverage of that New York
• 32:10Times economist, also a film,
• 32:11if anyone prefers to sort of consider
• 32:14this through the film medium,
• 32:16a lovely documentary called Mainland that
• 32:18follows 2 Chinese international students
• 32:20at a private boarding school in Maine.
• 32:23Um, again,
• 32:23we don't have to go into the details,
• 32:25but you can imagine all of the
• 32:27many stressors that accumulate on
• 32:28these international students in
• 32:30addition to their cultural language,
• 32:31etcetera.
• 32:33And so when there hadn't been
• 32:36really any research done,
• 32:37international student mental health
• 32:39and so our group again used the
• 32:41same data set to to look at this.
• 32:42We had about 2400 international
• 32:44students and a sample of about 40,000
• 32:47overall students in this ACH, ACH,
• 32:51a sample and we saw the exact same.
• 32:55Pattern that we saw with the Asian students,
• 32:57which is the lower rate of
• 32:59mental health diagnosis,
• 33:00but a much higher rate of ever
• 33:02attempting suicide in the
• 33:03international student population.
• 33:04So that was one of the first
• 33:06studies to actually specifically
• 33:07examine international student
• 33:08mental health nationally.
• 33:09And what we often hear from the international
• 33:11students is just the same stigma,
• 33:13but sort of amplified,
• 33:15especially with privacy concerns
• 33:16about who's going to know,
• 33:18especially when my status in
• 33:20this country is so tenuous.
• 33:21OK,
• 33:22so with that broad overview,
• 33:23I'm now going to shift into talking
• 33:25about specifically.
• 33:25The impact of COVID-19 and what
• 33:28we've seen since then,
• 33:29no one who was paying any
• 33:31attention from the use,
• 33:32could have missed the steady drum
• 33:34beat of a terrible headlines that came
• 33:37from around the world last spring,
• 33:39two springs ago in the wake of
• 33:42the onset of the COVID pandemic.
• 33:45And it was sort of through social
• 33:47media but also through mainstream
• 33:49media about racial assaults,
• 33:51people getting spat at,
• 33:53punched, attacked with knives.
• 33:55Verbally harassed,
• 33:56pushed in front of trains all
• 33:58over the world and as is often the
• 34:01case with these sorts of issues,
• 34:03the people who were targeted
• 34:04were often the most vulnerable,
• 34:06meaning young people and the
• 34:08elderly and women.
• 34:09And so here's one news article
• 34:11that showed that one in four Asian
• 34:13American views had experienced
• 34:15racist bullying during this period,
• 34:17culminating in last March the shooting,
• 34:20the deadliest law shooting of
• 34:22eight individuals,
• 34:23six of whom were Asian women.
• 34:26So one national clearinghouse that had
• 34:29been tracking these incidents from
• 34:30the beginning is called Stop API Hate.
• 34:32And they were among those to find
• 34:35that there was 150% increase in
• 34:37anti Asian hate crimes during a
• 34:39period during the pandemic when
• 34:40there was actually a 7% decrease
• 34:42in overall hate crimes.
• 34:44So it definitely was a real phenomenon.
• 34:47They did a they released a youth report
• 34:51early on that showed that almost actually
• 34:54this number rose to about 10% of the hate.
• 34:56Incidents that were self reported,
• 34:58involved in physical assault
• 34:59and that although adults were
• 35:01present in almost half the cases,
• 35:02there were only interventions in about 10%.
• 35:05And so one of their youth interns
• 35:07had this quote and which I think
• 35:09is representative of how many
• 35:10people were feeling at this time.
• 35:12The constant feeling that I must have a
• 35:14heightened awareness of my surroundings
• 35:16whenever I go outside or my family
• 35:17goes outside and they go vulnerable.
• 35:19Of course it did. Paul Watson,
• 35:22Abbe, who's a professor in Boston,
• 35:24was quoted in the globe around
• 35:26that time basically pointing out,
• 35:27you know, he,
• 35:28he studied Asian American history.
• 35:29And so he was pointing out that it's
• 35:32not that any of these stereotypes and
• 35:34frustrations and racisms is is new.
• 35:37It's just that this type of event seemed
• 35:39to allow airing of it to become permissible.
• 35:43The floodgates were lifted.
• 35:44And so this led to my own racial
• 35:46reckoning because I realized that
• 35:47as an Asian American myself,
• 35:49I had very little.
• 35:51Knowledge, actually,
• 35:52of the history of Asians in this country
• 35:54and some of what they had been through.
• 35:56And so as I started to read more and
• 35:59learn in part for talks like this,
• 36:01I discovered this long history.
• 36:04You know,
• 36:04there's always been a history of stereotyping
• 36:07foreigners as dirty and diseased outsiders.
• 36:09That includes the Chinese,
• 36:10also the Irish,
• 36:12eastern Europeans.
• 36:13But that stereotype has remained
• 36:16especially affixed to Asians.
• 36:18So in the early 1800s,
• 36:19Chinese were commonly regarded as dirty.
• 36:21We then wrap meters,
• 36:22and I'm giving you here an example
• 36:24of an advertisements printed
• 36:27from around that time period,
• 36:29which sort of not so subtly
• 36:32equates Chinese people with rats
• 36:34as well as people who eat rats.
• 36:36And with increased Chinese
• 36:38immigration in the 1850s,
• 36:40a lot of Chinese were trying to escape
• 36:42economic chaos at home and try their
• 36:44luck within the California Gold Rush.
• 36:45This just led to more and more negative
• 36:47depictions in the mainstream media.
• 36:49Chinatowns often became
• 36:50associated with vice and disease.
• 36:52And so here's a quote from an editorial from
• 36:54the New York Daily Tribune around that time.
• 36:57He referred to the Chinese as uncivilized,
• 36:59unclean and filthy beyond all conception,
• 37:02without any of the higher
• 37:04domestic or social relations,
• 37:05lustful and sensual in their dispositions.
• 37:07Every female is a prostitute
• 37:09of the basest order.
• 37:10The first words of English that
• 37:12they learn are of obscenities.
• 37:13So you get the the picture.
• 37:15And so these like stereotypes
• 37:17that were fixed early,
• 37:18are very pernicious and and long lasting.
• 37:22As I mentioned,
• 37:23Asians became seen as a threat.
• 37:25They were coming to work,
• 37:27especially men.
• 37:27And so some of the legal things
• 37:29that were instituted were to
• 37:31forbid women from coming so that
• 37:33Chinese people wouldn't have kids
• 37:34here and then propagate.
• 37:36So it was all men,
• 37:37and they became known as
• 37:39the Yellow Peril in the
• 37:41late 19th century.
• 37:43Basically their work ethic.
• 37:44They were willing to do a
• 37:46lot of work for less money,
• 37:47and it provoked this racist backlash.
• 37:50So you can see this.
• 37:52Editorial cartoon in the Wasp on the left,
• 37:54where the the caption says,
• 37:57what shall we do with our boys?
• 37:58And you can see all of these white men
• 38:01kind of hanging around with nothing
• 38:03to do because this Chinese grotesque
• 38:05man on the left with eight arms
• 38:07is sort of doing all of this work,
• 38:10sort of taking over the economic
• 38:12opportunities available to white people.
• 38:14On the right is a similar type of
• 38:16message that this huge American
• 38:18kind of Gulliver looks a little like
• 38:20Abraham Lincoln is being staked.
• 38:22Down by these Chinese tiny little effusions.
• 38:24So these are sort of demeaning
• 38:26depictions of the Chinese and sort of
• 38:29being almost subhuman in human people
• 38:32who are willing to work robotically
• 38:35and and tie down the American man.
• 38:38This here is you need.
• 38:39This phobia of course spread
• 38:41beyond the Chinese to other Asian
• 38:44cultures and ethnicities.
• 38:47There was actually a rise in anti Indian
• 38:50sentiment from increased Indian immigration,
• 38:53sparking what was called the dusky
• 38:55peril which I had never heard
• 38:57of until doing this research.
• 38:59And these stereotypes of the yellow
• 39:03peril were contrasted with the
• 39:05fact that there were presidents
• 39:06of Asian people in the US.
• 39:08Against the backdrop of exclusion
• 39:10of people trying to keep them out.
• 39:12And so these combined to form
• 39:13another stereotype that is still
• 39:15exists today called the perpetual
• 39:16foreigner stereotype that it doesn't
• 39:18matter how long you've been in this
• 39:20country or how many generations,
• 39:21you're not from here, you're not American.
• 39:24And so here's an example of this
• 39:28that was sort of during the during
• 39:30World War 2A cartoon by Doctor Seuss.
• 39:34You can see that these are Japanese
• 39:36people being depicted with very
• 39:38stereotypical features they're lining up to.
• 39:40Obtained their bricks of TNT
• 39:42and from this person working at
• 39:44the Honorable 5th column,
• 39:45and the person up top has the Periscope
• 39:48looking out West, past California,
• 39:50presumably back to Tokyo,
• 39:52waiting for the signal from home
• 39:54to do some sort of dastardly deed.
• 39:56And so perhaps it's no surprise
• 39:58that with these depictions of
• 40:00Asians essentially as untrustworthy,
• 40:02sort of loyal to a foreign government that
• 40:06in 1942 the Japanese Internment Act was.
• 40:10Signed into law by President FDR.
• 40:14So 120,000 Japanese Americans were interned,
• 40:16over 60% of whom were U.S.
• 40:18citizens.
• 40:18And this action was declared constitutional
• 40:21by the Supreme Court at that time.
• 40:23And so that sort of anti Asian sentiment
• 40:26of course eventually got coded into law.
• 40:28We had the Chinese Exclusion Act of 1882,
• 40:31which banned all Chinese from coming to
• 40:33America with a handful of exceptions.
• 40:35That was the first time in U.S.
• 40:36history that a single group
• 40:37was excluded based on race.
• 40:39But of course it wasn't going to be the last.
• 40:41We then have the Immigration Act of 1917.
• 40:44Which expanded basically was trying to
• 40:47restrict undesirable immigration from
• 40:48everywhere other than northern Europe.
• 40:50So decrease the put quotas on
• 40:53Eastern European immigration,
• 40:54but essentially stopped all
• 40:55immigration from Asia and this kept
• 40:58getting perpetuated and propagated.
• 41:01Now it's actually almost head
• 41:02spinning how quickly that changed
• 41:03towards the end of World War Two.
• 41:05Sort of. Strategically,
• 41:06some scholars have found that the Chinese
• 41:09became seen in a more favorable lights
• 41:11as a way of countering Imperial Japan.
• 41:14And so there was a strategic decision
• 41:16made to try and Curry favor with
• 41:17China in the war against Japan.
• 41:19So we started we allowing certain
• 41:21Chinese people in and the the Citizens
• 41:24Committee to repeal Chinese exclusion
• 41:26kind of recast Chinese as law abiding,
• 41:29peace loving,
• 41:29courteous people living quietly among us.
• 41:32So suddenly a shift from the yellow
• 41:34peril Cooley hordes and then you
• 41:36start to see the term model minority
• 41:38used widely in the mid century.
• 41:40So there's a New York Times article from
• 41:421960s that describes Japanese Americans.
• 41:45As this model group that we know today,
• 41:48but it's really not that long ago
• 41:50actually that this shifted and a lot
• 41:52of research have gone into that.
• 41:54So we might think that some of this
• 41:56is is not really here anymore or
• 41:58certainly Asians wouldn't use it.
• 41:59But here is a recent example Andrew Yang,
• 42:02the presidential candidates had actually
• 42:04written an op-ed that was widely panned
• 42:07in the Asian community where he said
• 42:09he he basically embraced he urged
• 42:11Asian Americans to fight anti Asian
• 42:14hate by embracing their Americanness.
• 42:17In ways we never have before.
• 42:19And so he literally said it's our
• 42:20job to get out there, step up,
• 42:22donate, volunteer,
• 42:22and show without a shadow of a doubt that
• 42:25we are Americans who will do our part
• 42:27for our country in this real time of need.
• 42:29And again,
• 42:29probably his intentions here were noble,
• 42:31but unwittingly,
• 42:32he's just perpetuating this
• 42:35perpetual for foreigner stereotype.
• 42:37As many commentators also observed,
• 42:391 stereotype just gives way to another.
• 42:41So even if we seem to have been protected
• 42:44by the model minority stereotype,
• 42:46COVID kind of showed how quickly one
• 42:49stereotype will just turn into another.
• 42:51And a lot of research have gone into this.
• 42:54It's ongoing.
• 42:54Clearly people who experience racism do
• 42:57have negative mental health outcomes,
• 42:59including depression, anxiety,
• 43:01and PTSD like symptoms.
• 43:03That same group stopped the API heat that I
• 43:05mentioned before had some interesting data.
• 43:07They found that those who experienced
• 43:10racism reported being more stressed
• 43:11by the racism than by the pandemic
• 43:14itself that had killed hundreds of
• 43:16thousands of people at that point.
• 43:18But also interestingly,
• 43:19after reporting their incidents,
• 43:21those who experienced the racism
• 43:23had lower symptoms of race based
• 43:25traumatic stress,
• 43:25implying again that actually taking
• 43:28action and doing something about
• 43:30it seemed protective mentally.
• 43:32I won't go into detail folks here I'm
• 43:34sure are aware that you know racism
• 43:36can be experienced as a trauma.
• 43:37And often is.
• 43:38It's one of the many isms that
• 43:40adds disproportionate burden to those
• 43:42who are minoritized in this society,
• 43:44and many theories as to why.
• 43:47But we do also know this is a
• 43:49commentary we wrote in the American
• 43:51Journal of Public Health about the
• 43:53impact of COVID on public health.
• 43:55But we for example know that from
• 43:58Japanese who were interned compared
• 43:59to their non intern counterparts,
• 44:01they were about twice as likely
• 44:03to attempt suicide as well as to
• 44:06experience mycardial infarction.
• 44:07So these types of incidents that are deeply
• 44:10felt live on in the body as we know.
• 44:12Now I'll wrap up the section by saying
• 44:14I think what the last couple years have
• 44:16shown us is that race is not black and white,
• 44:18even though often that's how it's portrayed.
• 44:21We know that there is no National History
• 44:24curriculum to mandate any teaching
• 44:26at all and that for most districts,
• 44:29Asian American history and completely or not,
• 44:31thoughts.
• 44:31And if you think about why that is,
• 44:33maybe that it doesn't portray the
• 44:35US in a particularly positive light.
• 44:37And so I think Asians have often felt
• 44:39unclear about whether they are a
• 44:40minority and whether they are actually white.
• 44:42And I think over the past couple
• 44:44years has has suggested that maybe
• 44:46that's not the case.
• 44:47If you want to educate yourself on this,
• 44:49I highly recommend this sort of five
• 44:51or six episode Asian Americans PBS
• 44:54series and it does a fantastic job
• 44:56of providing a high level overview
• 44:59of the history of Asians in the US.
• 45:01Society though,
• 45:02so I think some of the positive things
• 45:04that we've seen that people are now
• 45:06speaking up and people in society
• 45:08are speaking up on behalf of Asians,
• 45:10Asians themselves are organizing in
• 45:12ways that have not previously been seen.
• 45:15There have been a lot of discussion
• 45:16about you know,
• 45:17Asian,
• 45:17anti Asian humor which seems to
• 45:19still be very acceptable in a lot
• 45:21of quarters in a in a way that you
• 45:24wouldn't do for other minoritized
• 45:26groups and additional additionally
• 45:27as I mentioned our community is
• 45:30speaking up and organizing.
• 45:31That being said,
• 45:32just a word of caution from Jay Caspian Kang,
• 45:35who's the writer in the New York Times.
• 45:36It's interesting that racial identity
• 45:39might primarily arise from racism,
• 45:41right?
• 45:41Because when you think about Asians
• 45:43being such a diverse group,
• 45:45how often do they consider themselves Asian?
• 45:48And I think about my own parents,
• 45:49who would refer to themselves
• 45:51as Taiwanese over Asian.
• 45:52So that's something that Jay Caspian Kang
• 45:55points out and and how durable they'll
• 45:58these bonds be if racism decreases.
• 46:00And so finally, I'll end my talk.
• 46:02They're just sharing a bit about what
• 46:04I've been trying to do about this,
• 46:05and then we'll open up for questions.
• 46:07So my own mentor, Albert Young, as a PG,
• 46:11Y2 resident, when I met with him,
• 46:12said,
• 46:12how do you take this great training
• 46:14that you're getting in all these
• 46:15fancy places and make it available
• 46:17to people like your parents?
• 46:18And with that, it was sort of
• 46:20like crystallized in my mind.
• 46:21I didn't realize kind of the
• 46:22journey that I was on, right.
• 46:23I don't think often we don't
• 46:25know until looking back.
• 46:26But thinking about it was like,
• 46:27of course that is what I've been doing,
• 46:29trying to like,
• 46:30help my parents understand mental
• 46:31health and help people like them.
• 46:33And So what I discovered at South
• 46:35Cove was this idea that like,
• 46:36try and treat people doesn't often work.
• 46:39You know,
• 46:39they would often drop out of treatment.
• 46:40They didn't want to buy what I was selling.
• 46:43And so I said,
• 46:43rather than beating my head against the wall,
• 46:45maybe if our treatments were
• 46:46excellent and people got better
• 46:48immediately they would come.
• 46:49But that's not the case yet.
• 46:50And you need a relationship and
• 46:52you need motivation and engagement.
• 46:53So I began to shift my focus and I said
• 46:55maybe the the purpose of my life is not,
• 46:58you know, becoming the most
• 47:00outstanding psychopharmacologist,
• 47:00but actually trying to understand the needs
• 47:02of this community that I'm trying to help.
• 47:04And then shift the way that
• 47:06we present our services.
• 47:07And so knowing that,
• 47:08you know what motivates
• 47:10immigrants to come here,
• 47:11it's usually almost always for their kids,
• 47:13for opportunities for the next generation.
• 47:15And so we began to think of this
• 47:17almost as a marketing challenge.
• 47:18How do you sort of make the case
• 47:20for the importance of emotional
• 47:21Wellness for long term success?
• 47:23And I always joked that I,
• 47:24as a psychiatrist,
• 47:25even trained in Ivy League
• 47:27education institutions.
• 47:28If I were to give a talk and
• 47:29advertise and put a flyer about
• 47:31I'm giving a talk about depression,
• 47:32the room would be maybe 25%.
• 47:34From.
• 47:34If that,
• 47:35like if I give a talk about
• 47:38success and the importance of
• 47:39emotional Wellness for success,
• 47:41then the room is not only full,
• 47:42but there's a line out the door
• 47:43and there's people lining up
• 47:44afterwards to ask questions.
• 47:45So it's really just a matter of framing.
• 47:47And we really deemphasize sort of
• 47:50formal psychiatric diagnosis at
• 47:521st until there is that buy in.
• 47:54So we were founded shortly after
• 47:57I completed my residency in 2014.
• 47:59And then really informed by again
• 48:01the needs of the Community,
• 48:03one of the cofounders, Lucia Liu,
• 48:05and the top right was a private
• 48:07practice psychiatrist who was
• 48:08getting a ton of referrals of
• 48:09Chinese water national students.
• 48:10And she said, hey,
• 48:11we could like open a business together.
• 48:13But as we talked about it more,
• 48:14became much more interested in
• 48:16sort of the the academics component
• 48:18of this and how do we understand
• 48:20this and how do we go upstream
• 48:21to try to educate and prevent.
• 48:23So this thing has grown over the
• 48:25past seven or eight years into
• 48:28a diverse coalition.
• 48:29We have lots of folks from
• 48:31around the country and even the
• 48:33world's bringing a diversity of
• 48:35professional perspectives and we
• 48:36are completely volunteer operated.
• 48:38We don't get any support actually from MDHHS.
• 48:41So everything that we do
• 48:42is in our own free time,
• 48:44sort of as a passion project.
• 48:46It's not part of my FTE.
• 48:48So again, we are educational.
• 48:50We want to have these engage these
• 48:52conversations directly with the
• 48:54Community and hear some photos.
• 48:55When we could do that prior to COVID?
• 48:58One of the things that we did
• 49:00early on was to sort of focus
• 49:02in on the international student
• 49:03population because that was a very,
• 49:04that was again what was being referred to us.
• 49:08And so wrote this very brief
• 49:102 page commentary.
• 49:11And in jcap, this is literally it.
• 49:14These are the two pages and interesting.
• 49:16That got picked up not by the
• 49:17mental health community so much,
• 49:18but by the educator community who said,
• 49:20Oh my gosh, we are desperate for this.
• 49:22We're seeing this all the time on campus.
• 49:23We don't know what to do.
• 49:25And so we actually decided to
• 49:26start sort of a consortium program,
• 49:28which is a membership.
• 49:30Based program that schools can joins
• 49:32and actually it's a lot of high
• 49:34schools that like to join because
• 49:35they don't have a lot of supports.
• 49:36And so we do get regular talks,
• 49:38we do case consultation,
• 49:40we don't provide direct clinical care,
• 49:42but we can consult to the team
• 49:44and we've offered novel things
• 49:45like virtual support groups during
• 49:47COVID for the students.
• 49:49We recently completed our 4th year.
• 49:51So been a lot of work but also really
• 49:54fun because educators turn out to
• 49:56be great students and they love this
• 49:59and they they want to delve in.
• 50:01We also again sort of trying to
• 50:03clarify our mission and what we
• 50:05do see ourselves as educators in
• 50:06a way to the professionals as in,
• 50:08in addition to the Community.
• 50:10So starting in 2021,
• 50:11we teamed up with the Let's talk
• 50:13Asian American Student Mental Health
• 50:16Conference at Harvard Graduate
• 50:17School of Education run by Josephine
• 50:19Kim at the upper right.
• 50:21The faculty there and Juliana Chen,
• 50:23who's part of our center started to
• 50:25create this sort of curriculum for
• 50:27educators and clinicians who want to
• 50:29better support the mental health of.
• 50:31Asian students and so we this
• 50:34was last year's curriculum,
• 50:36kind of a initial foray into this topic.
• 50:39This past year we held our second
• 50:42annual conference focused on anti
• 50:44Asian racism and racial trauma
• 50:45and had just an amazing we've had
• 50:48over 300 participants each year
• 50:49paying to come to this conference
• 50:51because they want to do a better
• 50:53job for their Asian students.
• 50:54We also directly provide
• 50:55direct education to community.
• 50:57We're always trying to figure
• 50:58out better ways to do that,
• 50:59so we've created fact sheets.
• 51:01Um,
• 51:01that are a little more tailored
• 51:03culturally and also translated
• 51:04into different languages.
• 51:05The idea being that if you took an
• 51:07IH fact sheet and translated it,
• 51:09I think most people would just
• 51:10sort of ignore it or throw it away
• 51:12if you handed it out because they
• 51:14don't see it as representing them.
• 51:15But if you can add in some things that
• 51:18sort of feel more culturally relevant,
• 51:20they will read it and they're interested,
• 51:22but it's about starting that
• 51:23conversation and getting them engaged.
• 51:25We do try to make things that the
• 51:27Community asks for and so as we were
• 51:29doing a series of free webinars.
• 51:31Uh, last year in the the height
• 51:34of the anti Asian violence.
• 51:37This was actually a direct comment,
• 51:39anonymous comment from a participant
• 51:41who said we want help talking to our
• 51:44kids who are born here about racism.
• 51:46And I was delighted because I was like,
• 51:48I never, my parents never talked to me
• 51:50and you know, we would never have this.
• 51:52So to see this represented to
• 51:53me a big change.
• 51:55And I said yes, we have to respond.
• 51:56And we all felt that way.
• 51:58It wasn't just me or our center.
• 51:59And so we put together sort of a toolkit,
• 52:02basically to give parents specific
• 52:04language that they could use and
• 52:06how webinars and try to disseminate.
• 52:07This for free into the community.
• 52:11We also were lucky enough to be
• 52:13granted a Robert Wood Johnson
• 52:14Grant as a doctor you mentioned.
• 52:18And so this is kind of the
• 52:20focus that we're doing.
• 52:21We're trying to basically build
• 52:23a very practical toolkit to help
• 52:25parents once they've come to the
• 52:27point where they say we need help,
• 52:28which many we are discovering,
• 52:30many parents are they,
• 52:31they quickly move from yes we need
• 52:33to change to tell us what to do and
• 52:35that's what we're hearing a lot now.
• 52:37So we're trying to tell them what to do
• 52:39and I think the chat together program.
• 52:41Similar trying to equip with direct skills.
• 52:45If we play this film,
• 52:46I think there's time. Film,
• 52:48I think is a is a critical tool.
• 52:51And I'm going to play this trailer
• 52:53from a film called Looking for Luke,
• 52:56which was Co produced by Joanna Chen,
• 52:59our associate director.
• 53:07Luke was
• 53:12mischievous, dorky, full of energy,
• 53:15extremely silly. He was curious.
• 53:17He found a question that he had.
• 53:19He wouldn't let it go.
• 53:20Questions of life, the purpose of life,
• 53:21the meaning of life.
• 53:23I think you would have turned
• 53:24into this really great professor.
• 53:27He was really smart.
• 53:28He was a presidential scholar.
• 53:30Math competition with.
• 53:32Growing up, you always heard
• 53:35your parents saying, be like him,
• 53:37achieve what he does and then all
• 53:39of a sudden don't be like him.
• 53:42He's made such a huge mistake.
• 53:51Today I'd like to talk about
• 53:54people and how we relate to them.
• 53:57Everyone has a story.
• 53:59Everyone has a reason for their behavior,
• 54:02whether we know it or not.
• 54:05It was like one of my best
• 54:06friends and I thought we wouldn't
• 54:07really go through life together.
• 54:13Wait, the biggest question,
• 54:14of course, was just why?
• 54:15Why would he do that?
• 54:17I was completely unaware,
• 54:18and I think most of his friends
• 54:20were unaware that he was struggling.
• 54:21With suicidal thoughts or these
• 54:24different questions at the funeral,
• 54:26they didn't say it was a suicide.
• 54:28They said he died from a chronic
• 54:31illness because in the beginning we
• 54:33were told not to tell what happened.
• 54:48Hi, how are you?
• 54:56I've I've seen this film probably 100 times
• 54:58and I cry every time I watch it because
• 55:00it contains so many of these themes.
• 55:02I'm talking about the breakdown in
• 55:05communications the tragedies and the
• 55:06families and and so many so many so
• 55:08much admiration for the parents who
• 55:10are actually willing to talk about it
• 55:12as opposed to keeping it on the rug.
• 55:14I know we're overtime so I'll I'll wrap up.
• 55:15We also do a lot of research our
• 55:18Director of Research Cindy Lou
• 55:19actually have just won an R1 and
• 55:21R21 to look at discrimination and.
• 55:23Racial socialization and Asian
• 55:24parent and youth mental health,
• 55:26which is amazing.
• 55:27Again, I think it was actually very
• 55:29rare to receive an R1 focused on Asian
• 55:31American mental health in the past.
• 55:33So I think things are starting
• 55:34to change because of all of
• 55:36this outcry that's happened.
• 55:37Finally, it's focus #3.
• 55:39We are not our clinical program.
• 55:40We all have full time jobs as clinicians
• 55:42and educators and there's just no way
• 55:44we all see patients in our practices.
• 55:46But it's really,
• 55:47this is a huge problem and I
• 55:48run the outpatient division MGH,
• 55:50so I know you know the critical
• 55:52lack of services.
• 55:53And so it's really thinking about what
• 55:55are the creative ways that we can
• 55:56actually get folks into the care that
• 55:58they need when they're ready to get it.
• 55:59So with that,
• 56:00I will stop.
• 56:01Thank you so much and please stay in touch.
• 56:02We'll open up for questions.