Yale Psychiatry Grand Rounds: October 14, 2022

October 14, 2022

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"Breaking Silences in the Model Minority: Asian American Mental Health Before and During COVID-19"

Justin Chen, MD, MPH, Associate Professor of Psychiatry, Harvard Medical School; Psychiatrist, Massachusetts General Hospital

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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.