[00:00:00] Christine Ko: Welcome back to SEE HEAR FEEL. Today, I'm really excited to be talking with Dr. Eunice Yuen. Dr. Yuen is an Assistant Professor of Psychiatry from the Yale School of Medicine and Child Study Center. She integrates clinical and research work in a bio-psycho-social cultural framework. She's interested in mental health from genetic and neurobiological underpinnings to practical interventions and education within communities. She looks at acculturative stress, a stress that is common to many immigrants, affecting children and families in a cross generational manner. Dr. Yuen is the founder and director of Yale Compassionate Home Action Together, which is also abbreviated CHATogether, and it's a program that uses interactive theater as an educational tool to increase wellness in Asian American families across generations. Dr. Yuen is also a Op-Ed Project/ Yale Public Voices Fellow with me this year. So that's partially how I'm getting to know her. It's really exciting to be able to spend this time with her today. Welcome to Eunice.
[00:01:04] Eunice Yuen: Thanks so much, Christine. I'm excited to be on this podcast, introduce myself, and also get to share my experience to everyone who are listening.
[00:01:15] Christine Ko: Thank you. Along those lines, could you share a personal anecdote about yourself?
[00:01:20] Eunice Yuen: I'm very happy to. When I was in teenager I was a parachute kid who experienced acculturative stress, moving to this country when I was in late teens. I was originally from Hong Kong. Some historical context at that time in 1997, Hong Kong was transitioning from the British back to mainland China. Many parents at the time, including mine, were terrified by what might happen to the future of a child. And I'm one of the children being sent, leaving home thousand miles away. Parachute kid: have no idea where my landing, in the US. And I'm also coming from a low income first generation family, the first college goer in my family.
[00:02:06] Christine Ko: Oh wow.
[00:02:06] Eunice Yuen: So that's where I start this acculturative stress. Eventually, now, many years later, I am a mother of two Asian American sons. My husband identifies himself as Taiwanese American. It's really interesting perspective to realize how I'm living in more than one culture. But think about as a parachute kid, from point A to point B. That process, it's really a long, twisting and turning, forward and backward, from point A to point B. And now I'm an adolescent psychiatrist, specializing in AAPI mental health. And so I think all these background and self experience added up together, as a nutrient, a motivation for how I started Yale CHATogether. Especially during pandemic, one question is about, Who are you? Who is your identity?
[00:03:04] Christine Ko: That's awesome. Thank you for sharing. I'd never heard of a couple terms you mentioned, especially "parachute kid". That sounds scary, right? The term itself, even, that you're just being launched off from Hong Kong and landing randomly. Because when you have a parachute, you actually are trying to hit a certain target, but you may not hit it.
[00:03:28] Eunice Yuen: That's just so true. I think that's why, how they frame it like that too. Especially in my family background, I know my parents sacrificed so much themselves to help me. In East Asian cultures, we embrace a lot of Confucianism, filial piety: honoring the parents, respecting the parents. And my parents have sacrificed so much for me to do this, to be a parachute kid. A lot of expectation at the same time, a lot of confusion. Fear and vulnerability to succeed.
[00:03:57] Christine Ko: So do you identify as Chinese American? Or really it's like a Hong Kong identity?
[00:04:04] Eunice Yuen: That's also an interesting identity question. Every time I go back to Hong Kong, I know I identify it as my home, and then when I'm in US, I also identify. Here is home, too. The identity of both. Being Asian and American. Yeah, I would say I'm Chinese American, but I feel that my home is US and Hong Kong. That's where my families are now.
[00:04:27] Christine Ko: I asked because, for listeners who don't know, I'm Korean American, and I'm fascinated by this question of identity in Asian American families because my parents were born and raised in Korea, in South Korea. Both my sister and I were born in the States. And I always thought I was Korean American just because my parents would tell me that I'm not really "Korean", which always felt a little bit like an insult almost. Not that they were deliberately trying to insult me, but it was, You guys are both Korean, and if I'm not Korean, what does that mean? And also I think as a child in an Asian culture you are supposed to be like your parents. So to be told many times that I'm just not was hard. Harder, I think,, than I knew at the time.
[00:05:18] Eunice Yuen: The developmental process started as more Asian coming to the US and gradually developing a little bit more American, assimilated, but also have some part of me retained. The ongoing developmental process is a life process for me. I'm wondering the same case is true for you, Christine.
[00:05:37] Christine Ko: I have thought about identity in terms of being Asian or not really being Asian, as my parents would point out to me my whole life. Because while I was born in the US, my family actually moved back to South Korea when I was in elementary school. I have two kids who are Korean American or American. I think they identify more as just American. My husband's Korean American, so they're ethnically Korean, ethnicity-wise. But I see the way they grow up and I'm like, Wow. It even more reinforces to me that I am not actually really Korean American or not, at least, the way they are, and the way that my husband is. Meaning that once we had moved to South Korea, I was much more in Korean culture, not fitting in. It was very different than America at the time. We went to an American school, but it was really quite different. We knew we weren't like the Korean kids who went to Korean school. It's fascinating to think about identity. For each person, like even for me versus my sister, it's a little different, even though the environment we grew up in is similar.
[00:06:44] Can you further define acculturative stress? Can you talk about that a little bit more?
[00:06:49] Eunice Yuen: Acculturative stress. It's a stress. It's not something negative or positive. It's an adjustment of living in several social, cultural environments. Like when I was a teenager living in an Asian country, there's no stereotyping; there's no microaggression, there's nothing like that. All of a sudden, coming to the US, it's very different. Different language, different food. The external environment would be different in the context of culture. Acculturative stress.
[00:07:18] That's what I meant when I mentioned the parachute kid from point A. Acculturative stress is still happening, ongoing. How we kind of embrace that, adapting to that every day to cope with this type of stress. It's constantly happening in the environment. So say for example, if in reverse, like now I'm going back to have a trip in Hong Kong. I would totally feel not fitting in as well. That stress is there.
[00:07:43] Christine Ko: Yeah, that's a good way to think about it. Thanks for explaining it that way, that it's really over years. Do you have tips for how to navigate acculturative stress?
[00:07:52] Eunice Yuen: We are all learning about how to adapt. Having social support, having people. Like you and I were talking just now, I feel that I'm connected. We're connected at that space to feel authentic. How to be authentic and be able to embrace your authenticity: that is actually really important. Over the years, especially at the beginning stage when I come, when I feel this acculturative stress, I feel that I'm trying so hard to fit in. In the United States or wherever that is, or like in the school, in the workplace, in the social cycle. And over the years, I realized, if I try to fit into one circle, I lost myself; and trying to fit back to another circle, I lost myself. If I try to fit back into the circle in Hong Kong, I lost myself. I don't feel I belong. So constantly finding you try to fit into a certain circle to feel content, and it does not work. You need to create and embrace yourself. I am both Asian and American. In some scenario, I'm more Asian. In some scenario, I'm more American. I can watch football games with my husband. I can celebrate Chinese New Year. I need to embrace my unique self in the acculturative stress adaptation. I feel so much better than trying to fit in this little silo to find myself, and I think that is part of the identity process.
[00:09:16] Christine Ko: Yeah, I love that. I really do. I would say that when you put it that way, I agree with you that one of the rare benefits of the pandemic has been, because it's been so taxing at different times for me, I have become more authentic. Only because I don't have the extra energy it takes to assimilate and force myself to fit in. So instead of trying to be some perfect mom or yeah, perfect wife, I'm like, my identity is this messy person right now who feels very disorganized and overwhelmed.
[00:09:55] Eunice Yuen: Yeah.
[00:09:55] Christine Ko: So one of the identities that I think about, that we both have, is physician and what I've been thinking about more and more is the medical culture, the culture that's in medicine, as a whole, in healthcare for doctors as well as patients. My bias right now is that the medical culture that we have right now, at this point in the pandemic, is causing doctors and patients, and everyone who's in healthcare, to suffer and burnout. And I think of that as an acculturative stressor, if I can use the term that way. I don't know if you agree or disagree or if you have thoughts on that?
[00:10:37] Eunice Yuen: We have so many different hats. Like you and I as mother, that's one hat at home. Another hat to be the physician, to take care of our patient. Another hat to be the leadership in the medical team. All these different hats, juggling or transitioning with different sort of mini psycho-social cultural circles. We set boundary and try to fulfill each of the circle, and in the process of transitioning, it definitely could create a lot of stress.
[00:11:05] I don't need to be perfect in each circle. I can say I need help. I can say, I'm tired. I need your help. And sometime when we speak up, people would know it and actually do something. Rather than internalize that stressor, talk about it. Find a circle who feel authentic feeling the same way. I think that is very therapeutic. And also be able to speak up when we really need help.
[00:11:29] Christine Ko: Yes. Your answer helps me articulate a little bit more the analogy that I have in my mind. The Korean culture that I was brought up in is very detached in terms of emotion and building relationships; building authenticity and being able to express what you really feel. And my experience, at least of medical culture, the culture in healthcare, is that it's also traditionally pretty detached, very paternalistic. The analogy in my mind is that I was brought up in this Korean culture to not question the rules or express emotion. And also in medicine, largely, follow the rules, the standards, the guidelines; the diagnosis, the treatment, the management plan; and emotion has no place. I acculturated or tried my best to assimilate into that model. Like you were talking before to push myself into that circle or square. I'm realizing more and more, it just doesn't work well for me. It's not the model of why I wanted to be a doctor, and it's not the model of how I would want to live my life and bring my kids up, either. Meaning, I don't want a model of, Don't question authority, like meaning if an authority is a doctor or a parent, in the healthcare setting versus at home. And, Hide your emotions, because emotions are just messy and useless.
[00:12:53] Eunice Yuen: My role as a child adolescent psychiatrist is helping people to open up the emotion, right? To share what they feel, be able to process, to understand, and to listen. I'm trying to navigate that as well. Anyone is a human being, including physicians, including leaders. I'm trying to actually set a really powerful message as a leader that it's okay to be vulnerable, not to burden other people about your negative emotion, but like to send a powerful message that it's okay to be sad, It's okay to be frustrated. Our children or our patient will be able to sense that. It's a permission to feel. Let them know they are okay to share, to speak their mind as well. It's a way to offer space to communicate. I think that could be a really interesting new way to manage people as a physician, as a mother, as a parent. Permission to feel is really important.
[00:13:49] Christine Ko: Permission to feel is very important, and I'm going to stop this episode here because Dr. Yuen and I went on to talk about what permission to feel really means, another concept called mentalization, and the importance of self-compassion in all of this. These things are really important, and I didn't want to shortchange them. So the rest of this conversation will continue in the next episode. Thanks for listening in.
