15 I The Model Minority Myth—Be small, Don't take up so much space, Don't cause trouble (Dr. Denise Yu)

• Timespan: 44 minutes and 17 seconds
• Transcription Type: Cleaned Verbatim
• Speakers: (Denise Yu& Raj Sundar)

00:00

Raj Sundar: So today we're gonna talk about the model minority myth.

00:02

Ron Chew: Each time a generation of people migrates over to a new place, there's a huge transition in terms of just purely learning the language, the culture, that norms. But there's what I describe as this immigrant sorrow. During my growing up years, my mother who immigrated in her 30s, I just remember this, she was sad all the time. Even in moments of happiness, it was sadness. Because she left behind family members, she left behind a place that was familiar to her.

00:03

Denise Yu: There is a lot of trauma coming from, you know, all these East Asian Americans of immigrants. And I think that kind of informed me a little bit of this model minority myth. The idea that this safety is a priority and to be safe and keep your head down if you become invisible, not realizing the true cost of that invisibility.

00:33

Raj Sundar:  Hi, you're listening to healthcare for humans Podcast, the podcast dedicated to educating you on how to care for culturally diverse communities, so you can be a better healer. This is about everything that you wish you knew, to really care for the person in front of you, not just a body system. Let's learn together. I'm Dr. Raj Sundar, a family physician, and a community organizer. Welcome to Season One, where we talk about the history and culture of immigrant communities.So that clip you just heard was from Dr. Denise Yu, a family medicine physician who eloquently describes the idea of the model minority. You know, up until now, most of our episodes have focused on the background and context of different communities. But today, we're going to talk about a specific topic, the model minority myth. Because as I do these episodes, common themes are starting to emerge from the different communities that I'm talking about or talking to. In addition to that, certain topics just need a whole episode for itself, to unpack what the term means and to dive deep into understanding that concept, or the issue that we're trying to address. The model minority myth is one of those concepts. Now, you may or may not have heard about this idea of the model minority, or the model minority myth. In the last few years, I feel like it's become commonplace this this term "model minority". But if you haven't heard about it, we're going to define that precisely in this episode today. But at the core of it, the model minority myth enforces the idea for many people that they should be small, should not take up so much space, and should definitely not cause trouble when they're harmed by systems that do not prioritize them, or acknowledge their humanity. The model minority myth itself has been applied to many Asian American communities, but also certain African communities. It's essentially been applied to immigrant groups that have thrived in systems that have been unfavorable to them. But they thrive anyway. There's a way to interpret that to talk about resiliency, and the hustle that many immigrant communities have had to learn to survive and thrive. But there are many aspects of the model minority myth that are problematic, it affects the mental health of your patients significantly. And more than that, this episode is also about your colleagues, the people you work with that bear this burden of being a "model minority", that makes them feel like they can't speak up, makes them feel like they don't have a voice, makes them feel like they have to be quiet and suffer. Because that's what's been expected of them and that's what they've always been told. And that's a problem. Because we need everybody to be able to have a voice and speak up in order to change systems that are not working for patients, and are definitely not supporting the healers who are struggling in a system that does not prioritize their well being. We need everybody to take up as much space as they need to to be heard. This is important. In today's episode, we're going to talk about the history of the model minority myth, the problematic aspects of it, then we're going to connect it to the health, specifically the health of patients. And then Dr. Yu is going to share her own story of internalizing this idea of being a model minority, and how has affected her own mental health. As always, if this is your first time listening, go to healthcare for humans.org and sign up. If you liked this episode, subscribe and share it with one other person. Here's Dr. Yu. Doctor you welcome to the show.

04:32

Denise Yu: Hey, Raj, how are you?

04:34

Raj Sundar: I'm good. Let's talk about model minority. Denise, how do you describe model minority? I think people maybe have heard about it. Some people may know about it. Let's state the definition.

04:47

Denise Yu: Right. So I think the model minority myth is very much an American myth. And this idea started around the 1960s or so that Asian Americans, as a community have successfully integrated into mainstream culture, and that we've overcome all challenges of racial biases, and we are thriving. And specifically, this means that we all work really hard. We don't make trouble. We don't complain. We have two-parent households. We're a political, passive, neutral, cold. We're all naturally academically gifted and otherwise high achieving, but not enough to be like in leadership positions. But we don't make too much trouble about that. And that we have all successfully assimilated and thrived in American culture.

5:32

Raj Sundar: Wow, that was eloquent. I think you nailed it. It's better than all these definitions i'm reading about. So that's the essence of model minority, right, that one specific minority group has achieved a high degree of success, financial, educational, familia despite the structures and whatever history they experience, because of their work ethic, and culture, and we all should strive to be like them. Especially other immigrant groups. So now that we have the definition, I think it's helpful to get some context around it. I would start in the 1850s, where Asian Americans, specifically Chinese immigrants, were not the model minority at that time, they were exploited as cheap labor. They were stigmatized as lazy, dirty, and immoral, people who are coming into our country to do something that's helpful for our economy, but not somebody we need to aspire to, or something we should have a positive stereotype for. Let's talk about the context in the 1850s. Denise, you were bringing some things up around that time, what should we talk about?

6:42

Denise Yu: Yeah, basically, in the 1850s, in China, they're a bunch of opium wars. And briefly, you know, Britain wants to keep selling opium to the Chinese population. China says no, and Britain says Oh, screw you. And they started a war. And then eventually Britain and French, when the war resulted in a huge loss of territory from China and an unequal treating huge amount of reparations that China has to pay to Britain and France, which is a huge amount of money is so much of their GDP, that they're not really expected to be paying that within the next century or so. And then there was a second Opium War, which was really more of the same. But most of these Opium Wars were happening in the Canton region in South China. Right. And so we're also seeing a wave of immigrants who are trying to leave their war-torn country. And so we see a lot of them come into America, like the gold rush for cheap labor to build the railroads as well. And initially, they were tolerated. Right. But once they were perceived to be threatening to white Americans, that's when they became demonized. So Chinese immigrants are often used to break wage strikes with Irish workers who at that time, who were another vulnerable minority at the time. So there are lots of massacres lots of anti-Chinese sentiment, there's the Chinese Exclusion Act, which you briefly discussed before.

7:55

Raj Sundar: Let's bring that data up, again, For people who don't remember 1882, the Chinese Exclusion Act is an Act. And I think it's helpful to remember that date, because that's when the US decides, hey, let's just exclude this large group of immigrants because we don't want them here anymore.

8:13

Denise Yu: Right. And so the Chinese existed in this really great area, because they also at the time, were not allowed to become citizens, right? So even if they're born there, they cannot be citizen. They are forever a foreigner, and they're excluded from immigration into the country as well. I will say that there was exceptions to the Chinese Exclusion Act. So if you're a merchant, a student, teacher or diplomat, you are not part of that Exclusion Act. So a lot of Chinese people ended up registering as restaurant owners to be able to come into and stay in America.

8:42

Raj Sundar: Thanks, Denise. So at this point, there's still no model minority, right? We're just minorities who are here, who we sometimes want, and sometimes don't. And then 1940 Japanese internment starts after Pearl Harbor. And then what happened during that period is, Japan had propaganda about American racism. Can you call it propaganda? Just maybe telling people what's happening in America? I don't know about how, Hey, did you know America just won't allow any Chinese in their country and they're actually racist. So then in 1943, we decided, the US, would repeal the Chinese Exclusion Act to counter this message or propaganda that, "hey, like, actually, we're not racist". And Chinese Americans have recast as good Asians, in contrast to bad Japanese because of the historical context of World War Two and what's happening. And so in the 1950s, and 60s, so many Asian Americans, right, Japanese and Chinese have experienced this back and forth and whiplash about do they belong here or are they welcomed here? And terrified by the xenophobia and disenfranchisement they continue to experience. They attempted to keep their heads down and assimilate into American society because they were also getting explicit and implicit instructions that you need to assimilate. So that's what happened. And then in 1965, the Immigration and Nationality Act of 1965 was passed, which allowed more immigrants from Asia. Remember that nobody from Asia could really come here, with a few exceptions. But there was a new tiered system where preference was given to skilled immigrants, with relatives already in the US, and steep barriers to entry for poor and working-class immigrants. I think that's helpful because now people sometimes look at the broader Asian American population. There's a lot of diversity that we'll talk about that. But they say, "Hey, like this portion of the population seems to be really successful". There was some self-selection because of immigration policy who came into this country, not necessarily, the culture of work ethic wasn't the only variable involved in this "success". But the model minority, the idea of model minority came about in 1966, or at least people attribute it to this specific article, which was a success story calling Japanese American style by William Peterson in New York Times Magazine. National Geographic had this article to talk about this article. And I loved how they summarized it. This is what they said. The article talks about how Japanese Americans in spite of being interned by their own government, managed to succeed and become contributing members of society without making a big fuss about being imprisoned against their will. This is a minority that has risen above even prejudice criticism. And they had achieved all of this, "by their own almost totally unneeded effort". They're law-abiding-, hardworking, well educated, and even well dressed immigrants. And he contrasted them with black Americans who he claimed were, "problem minorities", who had rightfully earned some of the prejudice against them. So you can see there's a lot of components to this one is highlighting a specific group of people saying, "hey, look how they succeeded and didn't complain", and then pitting them against another minority, especially during the time where people were fighting for their own rights. Anything to add to that, Denise..

12:30

Denise Yu: I think going back to that shift in public opinion, you know, there was a lot of PR reason why the US had to be nicer to Chinese immigrants. Right after Pearl Harbor, China became one of the first allies of the US during World War Two. And thought maybe the Chinese Exclusion Act really wasn't too diplomatic. And so they partially repealed the Exclusion Act right with the Magnuson Act, and that only allowed 105 immigrants per year. So it didn't fully open up the doors but it did start it. But again, was just another example of how Chinese Americans have been upon for the white majority, you know, they use us as they see fit. And the situation was very political PR reasons. And, of course, later using us to pit us against the black community as well. And I think the other context to add is that, you know, during all of this in China, there was huge upheaval, so the Communist Party takes over, Chairman Mao comes to power, there's a cultural revolution, the great loop for that result in mass famine, and there are these ongoing struggle sessions, which are just events to publicly shame, torturing kill people. And there is true scarcity, for socio-economic advancement for the population in general, right, there's limited access to school, only 5% of high school grads who want to go to college are actually able to. And so when the act got fully repealed in 1965, now we're seeing a lot of people come new immigrants from China who yes, are more highly educated, maybe more professional, in terms of their occupation, but they're also coming from a very war-torn country, very volatile regions, and from very recent, significant poverty and so there's a history of like violence and generational trauma from both the new immigrants coming over during the 1960s. And also from the immigrants who've been here since the 1850s. And having to deal with the terror and the massacres that they've been victims the of whole time that they've been here. And so there is a lot of trauma coming from, you know, all these East Asian Americans of immigrants. And I think that kind of informed me a little bit of this model minority myth, this idea that safety is a priority and to be safe and keep your head down, you become invisible, not realizing the true cost of that invisibility.

14:47

Raj Sundar: Well said, Denise.  Okay, let's break this down. Model Minority is that concept. In a myth was added on because we say it's not true. What are the problems with the idea of model minority? Hey, Asian Americans make a lot of money, and they're really successful. So aren't they the model minority, Denise?

15:06

Denise Yu: I mean, yeah, you would think that this is a really good stereotype, right? Because we got a lot of money. We got a lot of good jobs. We have really good homeownership. So I guess some statistics seemed to back up the model minority myth right? They're we're saying that you know, Asian Americans in general, had higher levels of education, higher levels of income, higher levels of socioeconomic status, and professional occupation, as well. But the problem is with a model minority myth, it homogenized our experience. It assumes that all Asians have similar backgrounds, values, goals, and experiences. It's assuming that East Asians are similar to South East Asians who are similar to the Pacific Islander and Native Hawaiian population, as well as the various populations and communities within India. And so when you break down the statistics, what you actually see, for example, in terms of like poverty rate, so poverty within the US is about 12%. Overall, for Asian American, it's also 12%. And you think, great, that's not bad, you're doing great, you're hitting that benchmark. But when you break it down between different ethnicities and races, you see that the Hmong population actually has a poverty rate of 38%, compared to the Japanese population which has about a 10% poverty rate. And so there's a huge disparity within the "Asian American minority". And I think we see an even better example of that when we look at education level, right? And so for people who are 25 years or older, and do not have a high school degree, overall, that's about 15%. So pretty low within the US. And if you look at Asian, 11%, like we're good, right, we're doing so good. But again, if you keep breaking down Cambodians, 39% of them do not have a high school degree. Look at the Hmong people, 40%, Latin, 34%, and then the Vietnamese 51%. That's huge. That's such a huge disparity within the population. And because they get lumped together with a bunch of these high-performing East Asians and South Asians, they become invisible.

17:05

Raj Sundar: Okay, I'll take that answer, Denise. Originally, we thought the Chinese were model Americans, then we said Japanese and then we said all Asian Americans. Yeah, Asian Americans are a big category with over 50 countries, with twice as many languages and dialects. And we collapse individual achievements and mask disparities and discrimination. I get it. Let's just say Chinese, Japanese, and Indians. I'm Indian. How about we just say we're the model minority? Let's not include all the Asian groups. Can I say that? What's wrong?

17:38

Denise Yu: I think there's an idea again, that this is like a good stereotype. Right? But I think what it does, again, is that it homogenizes all of our experiences, all of our backgrounds, and it cheapens our achievements. And it punishes those who don't conform. You know, if I excelled in school, it's because I'm naturally gifted and didn't have to work hard. And if I don't excel in it, it must be because I'm lazy, or just, you know, I'm really, really dumb. And the author, Dr. Jenny Wang, she spoke of this in her book "Permission to Come Home", where she was struggling in school in third grade. But instead of a teacher suggesting extra one on one help after school, getting a tutor, etc, which is typically what is offered to other struggling students. She wasn't offered that and she was just devised to be held back a grade. And we see this often with Asian students who may struggle with learning disabilities because it's assumed whether consciously or unconsciously that they will succeed and whatever subject. And so when they don't measure up, it must be because they're lazy, or not intelligent, or that there's something inherently wrong with them, and they don't get offered the same resources. And this is the same concept that happened largest in academics but in healthcare, employment, education, etc. And so it's a stereotype that creates this idea of us being almost superhuman, but also perpetuates this narrative that we're also subhuman as well, and really dehumanizes us.

19:02

Raj Sundar: Yeah, that's a whole another point. So I get it. Each community still has lots of individuals with different backgrounds. And it's hard to say, an entire country is a model minority. We all have different experiences. And it really dismisses our individuality. We hold on to this idea of a specific group is the model minority. I think I want to highlight the point you made that sometimes we're superhumans, and sometimes they're subhuman because this relates to some events that's happened in the last few years. Where this positive stereotype is "positive", although you just talked about the negative aspects of it, of being successful, sometimes that competence can lead to envy and competition, or the idea that you're competing. Hey, get out of my neighborhood. I don't have a job. Why are these Asians taking my jobs and the seats in my school or it can also lead to thinking "hey, these Asians like work super hard". heard, but they're like so cold and unsociable which leads to hate crimes like a subhuman part of it. Am I saying that right?

20:08

Denise Yu: It's like almost like a double-edged sword. Right that on one hand, there are all these quite, good characteristics. But on the other hand, there are also all these negative connotations that go along with that as well. And I think it's this idea that like, if you don't fit into this narrow definition of what it means to be a good immigrant, if you step out of your lane, then you don't have any worth is I think the message that you're saying, and that your value must be earned because you don't have any value, intrinsically.

20:37

Raj Siundar: Okay, Denise. So when we talk about success, it's a specific kind of success, right? Because there's this thing called "Glass Ceiling". Tell us what that means to you?

20:47

Denise Yu: It's this idea, I think was initially started as a way to explain why we did not see more female leaders in the upper echelons of leadership within the C suite. This idea is that you can see, the leadership positions, you can see those people but something is blocking you. It morphed into something called the bamboo ceiling right to drive the disparity that we see in Asian Americans being in the upper echelons of leadership in the C suite in the executive suite. And this idea that Asians model minority myth, we're known to be hard workers will get our work done, we'll put our head down for the good of the team. But because we were passive, because we were so neutral, we don't have good leadership skills. And therefore, it is a way to justify our absence in the higher leadership position.

21:37

Raj Sundar: I think it's a good way to say it. And the last thing, just to highlight, again, is the model minority has a lot of problematic components, including collapsing massive diversity into one term. It has negative aspects to it. It's not just a positive stereotype. And success doesn't really mean success. The last part of it is it helps drive a wedge between different racial groups. Because it is saying that good minorities or immigrants should not fight against the systemic nature of any problems, that they just need to take it in stride. As I said, in that quote, by Peter said that the goal is to just keep working hard, even though we interned you against your will. And that's how people should react to suffering and injustice.

22:27

Denise Yu: That's used to discount and discredit the justice that the 1960s were demanding. And it creates this artificial hierarchy of races, right? It helps Asians feel superior. But so this culture dangles this credit. But because our phenotype will never be considered part of the dominant culture, we will never be on equal footing, because we will always be seen as foreigners. And I see many Asian American kind of buying into this there than other people of color because look how close we are to our white brothers and sisters.

23:00

Raj Sundar: I think, going back to that point of it seems so positive. And people, I think, challenge it less, and people aren't as vigilant about it. Even though it tends to enforce the belief that our fundamental differences among racial groups when we know race is a social construct. And it masks as we said, within-group differences and makes people part of that community feel out of place when they don't match this vision of who you should be. Let's transition and talk about health. Denise, that's what we're here to talk about. Seems like we're talking about a model minority, but it's closely linked to helping. There are a few things I want to talk about. But tell me how have you seen model minority myth manifest as negative health outcomes or positive if there are within your patients?

23:51

Denise Yu: Yeah, I think I see a very interesting spectrum of the population. So I see recent adult immigrants, so first-generation immigrants. I see 1.5 generation immigrants, so immigrants like me, who come over as children, second generation, third generation immigrants, so people who have been born in this country, but are the children or descendants of immigrants. And so I see adults, I see children, and I see a kind of a young adult, that kind of everything in between. I think the biggest effect I've seen is truly mental health. And so just recently, I had this patient, he was a 40, something-year-old, non-English speaking male, when he comes in with chest pain, right? And so he has already gone to urgent care. He's gotten the whole workup and I talked with him and very quickly, it becomes very apparent to me that his symptoms are not cardiac, and etiology but related more to his mental health and anxiety. And I asked him if he's been having stress or if he was worried about something because especially in the older immigrant population, there's a lot of stigma with mental health. I'm more likely to get a truthful response if I asked about stress, and if I were to ask directly if he was having anxiety, so I asked him this, he looks down, but he doesn't answer. I let the silence linger for about 30 or 60 seconds, I asked him again, and I get a very small nod from him, but he doesn't make eye contact with me. He doesn't want to elaborate any further. And I do my due diligence and make sure he's safe at home, has no access to guns, and has no thoughts about hurting himself. And for all these, "easy questions", he answers really quickly and sustained eye contact with me. But whenever I asked when he wants to share what else is going on, he clams up, looks down, he avoids eye contact. And this encounter really stuck with me, because I think in terms of his mental space, I think a lot of that is it's very similar to what we see in people who have internalized the model minority myth, but also a lot of the cultural aspects, especially in Chinese culture, as well, and how that hinders individuals from seeking care. And honestly, it was how I was maybe like 15 or 20 years ago, and I really saw myself and him not being able to have the skills to kind of even identify exactly what it is that you're feeling. And then on the other hand, the spectrum and caring for young professionals who have, "assimilated" into American culture, and having to deal with generational trauma, maybe they don't even have a name for it, but they're having systemic symptoms of it. Perhaps they were prentafied at a young age. So this idea of quantification, basically, not allowing children to be children. And my own personal experience has been when I was young, like around eight years old, having my parents ask me to translate for them certain medical documents or things I got in the mail, or having to translate other things like tax documents, like something an eight-year-old really shouldn't do. And my experience is not unique, right? This is very common among immigrants from any part of the country outside the US who need to navigate that. And also had this idea as the eldest female child that I need to do more household chores or take care of my younger sibling. So this turns a child into a parent into almost like a mini adult, and not allowing them to be children. And how does this play out years down the line? And what are the ramifications of that. And in addition, straddling two or more different cultures and value sets and feeling the tug of both struggling with the prior generations' values versus our own. And it's no longer just a generational gap. But it's also a cultural gap. It's also a language gap. And so you're dealing with these huge gaps that need bridges to cross and that it is very unique to the immigrant experience. And then part of the values that we were talking about was the older generation having this very set idea of what the map is to success. And maybe the young professional in front of me, is thinking, Did I mess up? Did I choose the right path that my parents set out for us? Or did I stray from the path? And do I have thoughts and feelings about that as well? I just think that there isn't enough education out there for people to even put words to what they're feeling and what they're experiencing.

28:02

Raj Sundar:Let's debrief, because you had a few different points there. One is people who don't even have the language to communicate, they stress and worry. I think that's the story that you expressed. And linking that to the idea of the model minority, just how we can all carry self-doubt, inadequacy, and psychological problems carrying that idea of who we're supposed to be in our identity. And we're not meeting those standards. I don't know what was going on for that person that you said. But I had a follow-up question I know what stuck with you. What should we be doing for people like that? When, Yes, there are so many unavailable resources. But how do we connect with somebody at that level? To help them feel like there's trust between us? if you wanted to share whenever you're ready, You can. And what does that connection look like for that first patient encounter? You said.

29:01

Denise Yu: After? Again, doing my due diligence, I asked him, I'm like, "How do you think I can support you? You want me to hear the options?" Right? We talked about counseling, we talked about follow-up with me, and we talked about medication. And when I say medication, he likes perk up, because that's what he's actually looking for. He wants a pill to fix this. And we talk about it. And eventually, I do end up starting him on the antidepressant. And I don't know if many other providers would have done the same without knowing more details of what exactly he's feeling or what's causing his anxiety and things like that. But again, I went over the risks, the benefits, and the potential side effects, and this was what he was really hoping for. And from my perspective, it seemed like the right thing to do, obviously, with close follow-up and things like that. And I think it helps build that sense of trust. Right, in the sense that he feels like he can come to me there is something that he was specifically looking for. And that seemed like appropriate treatment for him. And I hope that this would open doors in the future where he feels like, okay, as this doctor seems like someone who understands me on a foundational level, whether true or untrue, I would hope that he came away from that encounter with that feeling. And I hope that in the future that if he had other concerns or other thoughts that he would also be able to return and again with some of that trust. And something that I've seen in my patient population, and that once there's one patient who feels that trust, who feels that understanding, they start telling their friends and co-workers, and then all of a sudden, you see all these people coming in who all work at the same place, and who all heard you know that you were a good doctor and that you listened to people on that. You know, they trust you, even though my Chinese is not as good, as other pupils they believe that they can trust you. And I think creating that relationship is so important to be able to move forward.

31:03

Raj Sundar: Yeah, I love that. So what I heard from you is partly hide vigilance about, is there something related to mental health happening here, with the right vocabulary, you're talking about anxiety and depression, you're talking about worry and stress. Something that people can understand. And even though he didn't share everything, you've met him where he was, and kept talking about it in a way that was open until he felt like this was the right next step for him. And hoping that's the beginning of a relationship, maybe eventually he'll share more with you. But that takes time. But I thought that was excellent. What you just said there. The second part that you shared was about working professionals who are struggling in their way, juggling multiple cultures, who, as you said have been through parent defecation, which is interesting, because when I talk about don't use children for interpreting, we just talk about it from the context and perspective of, hey, like for adult problems, kids aren't going to be as good or accurate. But we don't think about what is their experience, and how's this affecting them for the rest of their life, putting them in these serious situations where you're asking them to translate about their parents' vulnerability and their foul ability, especially with kids. And you think about how we grew up for so long thinking our parents are invincible, and they know everything, right? And putting a child in a place very early on saying they're not, and you may lose them or they're sick. And that effect that people can carry on as it grows up. And I think there's awareness there because people don't even know it to consider how that could affect somebody's mental health growing up. But this is the follow-up question in that situation with that working professional that you talked about, who's carrying the model minority, the parental education, juggling multiple cultures. How do you show up for them to help them feel seen or heard? And what does that look like?

32:59

Denise Yu: Let me marinate on that question for a little bit.

33:01

Raj Sundar: This is the thing that it needs. Most people who don't even think about it are working professional cons, you're like, Oh, so you're like stressed at your job. But it seems, hey, you're making a lot of money. You're like an executive director, cool. Seems like overall, you're well, so it's just stressed at the job. Well, there are so many layers to this. I don't think people will bring it up if like, Wow, if I tell them about parentification,  will this person even understand? They've never even thought about it? Probably. And I'm not going to go through that, the hassle and burden of trying to explain all of that to this person. But I think there's a connection that can be made there. If a person feels like this person gets it, even though if they look like me, that's a plus. Even though they don't look like me, they seem to understand what I've been through. And in this day and age when I can't find people that look like me all the time. Like maybe this is where I start. And maybe they'll show up for me in ways I didn't expect. And I'll trust them a little bit more.

33:55

Denise Yu: On that note, a little off-topic. I was thinking about this thing work. Growing up, most of my friends were immigrants or children of immigrants. And it's almost like there is this like foundational level of understanding between children of immigrants and there is like almost the sort of trust if you ever go to your friend's house even ever see like what's that smell that is something that as an immigrant like you've never do, because we all have had a friend usually white has done that and how much shame you feel about that. Right? There's, I don't know. I feel like there was inherent understanding.

34:30

Raj Sundar: Classic immigrant story of bringing lunch to school. Hell, what are you eating? Like this what I call food? Sorry, it's like a PBNJ Right?

34:38

Denise Yu: Like I brought dumplings at school once and I've never done it again in like the next 30-ish years. I've never done it again, because of that one, shameful experience, even though dumplings are delicious. So getting back to your question about these patients. I think the biggest thing that we can do, and I know how hard it is with all our time constraints is just a I just asked question. For example, I have a lot of patients who are very unhappy in their jobs. And I asked them, like, what's keeping you there? Why are you still doing this? Is this what you wanted to do? And I think just keep probing and trying to see like, what their inherent motivation is like, why are you at this job that you hate? Can we prove it? If you feel like you can't, why? Why can't you pivot? You're 23 years old. I can't do that, because I'm old. But you can still pivot because you're young. And so I think just asking Him does take the time that does take trust, but I think it helps patients internalize and reflect on why am I doing this? Why did I go into finance, if I hate it? And I think the other thing that we can do for our patients was to remind them to have compassion for themselves. That they deserve compassion. They deserve to enjoy their life. They deserve to have value. That they have inherent value, that's not tied to their salary, that's not tied to their socioeconomic status or their education, or that they and of themselves are completely imperfectly perfect. That they, as a human have a value that does not need to be earned. And I think that this is such a huge part of this model minority myth that you have to keep your head down and work and you work. And there's this Chinese phrase called "Chi Ku", which basically means to eat your suffering. Right? That any suffering, you go through any cruelty, you just swallow it and it theoretically goes away, not realizing that it turns into this cancer that slowly spreads throughout your body. And but I feel like because of that there is this idea that you don't deserve to play, you have to earn it, it's not something that's necessary, it's not something that you need. So rest, or play, or just enjoyment is not, it's just not valued, it's not prioritized. And I think that can just be really powerful for some people. Because they've never been told that they've always thought they have to fight for it or earn it. And that they don't succeed in whatever artificial bar they have therefore they don't deserve happiness, or to play or to enjoy or whatever it is, might be available for them. I don't know. Does that answer your question?

37:09

Raj Sundar: Yeah, that was wonderful. I think what I heard was one, you can ask better questions with this awareness, and know where to probe, and where not to push too much. But you also know what beliefs people may hold that you could potentially reframe, which could be causing their mental health distress by understanding all of this.

37:34

Denise Yu: Thanks for summarizing my thoughts, so well. I appreciate it.

37:37

Raj Sundar: That's why I'm here. The one thing that I mentioned was we talked about the self-doubt and mental health aspects of the model minority myth. The other is about how we approach patients because I think we carry this bias sometimes of hey, like this person's educated, they know what's going on. I'm going to talk about colon cancer screening, or I'm going to talk about blank, but they probably understand it all. Let's get to the other stuff, and not do our due diligence, with certain topics. And there's a hypothesis that we do that more for Asian Americans because we believe in this idea of the model minority. So there's some implicit bias there, if not explicit prejudice positively. Right? Just differential treatment. Do you feel like that could be true? I'm just thinking about do I do that and probably right, because we're all biased, and we step in, we try to see where we need to zoom in and focus. And sometimes we make the wrong call. It's again, it's to challenge that I think we should ask more questions about do you understand all of this? And how to do this? Right?

38:47

Denise Yu: Yeah, absolutely. I think, um, I have a few thoughts on that. So early on, in my training, I was taking care of this pregnant Chinese-speaking only woman, and I'm really my training. So I will be gracious to myself for that. But halfway through her pregnancy, it becomes apparent that she does not feel financially secure, she is financially insecure, she's housing insecure, and food insecure, and would qualify for WIC and additional support. And I had not asked her because, in my mind, I had internalized well, like, she's Asian like she must be doing fine. Like she would have told me if she wasn't right and brushed it off. And so you know, moving forward, now I make it my standard of care to ask everyone almost I have to revisit, are you having any, like housing or food or financial insecurity. That was and was a huge takeaway for me. And I think a lot of other people must do similar things, where we think oh, like, they probably have someone who can help translate stuff for them, or they probably have a community or they have family or they have something that someone else who can support them, that I don't need to win. I think it is a very common problem.

39:51

Raj Sundar: Yeah, I think we covered all facets of it. Anything else that we're missing? How did the model minority myth affect you Denise? Share your story.

40:00

Denise Yu: So I am technically a 1.5-generation immigrant, right? So I came over when I was a child. And I think being able to reflect back on my life, and I think I had done a lot of work and well, last few years in terms of emotional literacy, and I've done a lot of self-education. And I think I am able to back and be able to say, wow, like, my family has gone through so much generational trauma. And it played out in very specific ways. And as a result, and lead to really maladaptive behaviors and myself, right? So these behaviors that helped me survive, my childhood, no longer became hopeful as an adult. And a lot of it was this idea of all these characteristics that play into the model minority myth. So this idea of respecting your elders, at your own cost, but seeing how as children we're not, it's not a reflex to be made small, right? Children are allowed, they live life and marry fully. And but somewhere along that line, somewhere in my development, I got conditioned, to be small, to not take up space. And like, see how that played out. And to my older years into my adult years. I think I agree with myself a little bit. I wonder, damned Denise "Why did you have to put yourself through that?. And I feel so much compassion for myself for going through all of that and still being able to successfully come out the other side. And I'm not perfect, I'm still learning. But I feel so much in terms of who I am as a person that I have intrinsic value, and of myself, that's not related to all these other benchmarks. And so being able to deal with that, it's just been an amazing journey. But I am very lucky that I've had a supportive community that's been helping me on this journey. And so I'll share a story where, you know, early on in the pandemic, I was feeling very burnt out, I was very depressed, I felt like I was failing my patients, especially my  Chinese immigrant patient population. And so I told my dad and like, I think I'm like, a little depressed. And you know what he says to me, without hesitation, he says, I thought you're better than that as if it was like a moral failing on my part, that I was depressed not because of this giant pandemic, or like everything else happening in our world that like a moral failing on my part. And I think that just goes to show you like, I'm thankfully I don't think I internalized it. If you're hearing that message throughout your whole life. You know how that ends up, turning you into someone who doesn't trust your own feelings, right? You don't trust yourself, you don't trust your own judgment. And having to navigate life like that can be so difficult. I do want to emphasize that even though we're talking about a lot of pathology. I don't want to insinuate that my culture is only traumatic and can only lead to multiple mental health illnesses. I love my culture, and our food is amazing. There are so many holidays, now we're all revolving around food. Our history is rich, our families are strong. We've survived so much trauma and grief, they also experienced so much joy and love and we care for each other. We care for our elderly. We feel a duty towards each other, for better or worse. I think we're imperfectly perfect just the way that humans are. And if I could choose any culture to be born into, I wouldn't change who I am. I think my culture is beautiful. It's not perfect, but it isn't beautiful. And I don't want to come off as just pathologizing was all like the population of people.

43:37

Raj Sundar: That was beautiful. Denise.

43:38

Denise Yu: Thank you.

43:38

Raj Sundar: Someone wants told me you don't follow Aretha Franklin. So I'm not gonna say anything else. Thanks for coming on the show with us.

43:44

Denise Yu: Thanks Raj.

43:47

Raj Sundar: Thank you for joining us on another episode of the healthcare for humans podcast. And if you'd liked this episode, go to Amazon music and share it with one other person and sign up at healthcare for humans.org to join our community. See you soon.

44:01

Speaker 3: This podcast is intended for educational and entertainment purposes only. Views and opinions expressed in this podcast do not represent any of the participants past current or future employers unless explicitly expressed so well. We seek advice of your physician or other qualified healthcare provider with regards to your own personal questions about what medical conditions you may be experiencing. This Healthcare for Humans project is based on Duwamish land that makes a regular commitment to Real Rental Duwamish.

The transcript ends here.