Episode

9a

Chinese-Canadian Psychiatrist On the Asian Human Condition (Part 1 of 2)

The Tiananmen Square Massacre of 1989, a fractured childhood with memory loss, and recovering from the trauma of immigration.

In Episode 9, Julian, the only Chinese-speaking psychiatrist in a large Canadian city weighs in on how the clashing of Western ideals with Confucian philosophy is at the heart of mental health issues amongst Asian immigrants and their families.

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EPISODE 9: Chinese-Canadian Psychiatrist On the Asian Human Condition (Part 1 of 2)

SPEAKERS: SEN, JULIAN

Sen: [00:00:00] Julian, welcome to the beyond Asian podcast. Thank you for making time away from parental care to be with me today.

[00:00:08] Julian: [00:00:08] Thank you so much, then it's a, it's a great pleasure,

[00:00:10] Sen: [00:00:10] right? I have been really looking forward to our interview. Not only because we've known each other for almost 20 years now, maybe even more.

[00:00:19] Julian: [00:00:19] I'm trying to remember. Astonishing me a long time, for sure.

[00:00:23] Sen: [00:00:23] Yeah. And you know, you know, one of the best things about getting older, there's so many nice things about getting older, but one of the best things about getting older is being able to kind of drop these years, you know, to say things like, Oh, I've known this person for 20 years.

[00:00:34] Oh yeah, yeah, yeah. You know, two decades ago we were hanging out in university.

[00:00:38] That's right.

[00:00:39]  Narration: [00:00:41] Julianne. And I met each other way back in our university years, I was a lost first year general sciences student and he was a second year biology student. While I'd like to be able to say that Julian and I simply had a natural affinity for each other,  the truth is it was all about the bagels.

[00:00:58] Every Tuesday, the biology students association bought freshly baked bagels for its student body. I wasn't a biology student, but I pass through the lounge in the mornings. After my early as 8:30 AM classes

[00:01:10]One morning. I ducked my head in to see if there might be some extra bagels laying around. Julian was there.

[00:01:17]Not only was he okay with giving me a non bio student, a bagel. He offered me too. With cream cheese. He was my friend from that moment on. I've been wanting to interview Julian for a long time. Having immigrated to Canada when he was six and under the guidance of his father, Julian grew up with a traditional Confucian education, which afforded him a masterful understanding of Chinese history, culture, and language.

[00:01:42] But layered on top of this is also an extensive education in Western medicine and specifically in psychiatry. This makes him the perfect guest for this podcast.

[00:01:52]Today, Julian is one of the few Chinese speaking psychiatrists and a large Canadian city.

[00:01:59]I realized that despite having known him for nearly 20 years, I never asked Julian in detail about what his immigration story was and how it was for him to grow up with such strong foundations in both the Eastern and Western cultures. And just what happened to him before the time that we met.      I

[00:02:19] Julian: [00:02:19] don't talk about that much.

[00:02:20]Sen: [00:02:20]    tell me a little bit about just how all of that was for you.

[00:02:23] What you can remember from it.

[00:02:25] Julian: [00:02:25] So it's very unusual, right? I mean, was, that was a horrible period of history for China. , so my dad and my mom obviously went through the cultural revolution. So 66, 76.  So my dad was 16 in 19, seven. so that's when the revolution caught him, I think the revolution catches up with the five different points

[00:02:45]  Narration: [00:02:46] The cultural revolution in China. One of the most cataclysmic events in the history of the Asian continent. Spending a decade from 1966 to 1976, this movement purged Chinese society of the remnants of its traditional and capitalist elements and replace them with its signature communism with Chinese characteristics.

[00:03:07] The massive restructuring of Chinese society brought about by the cultural revolution, including sending masses of city dwellers to the countryside, as laborers to reeducate them in Maoist ideologies. Many young college age, people were forced to work for several years in the countryside. Often for going higher education, as well as incurring severe health risks from poor living conditions.

[00:03:29] Mao has been quoted as saying the intellectual youth must go to the country and we'll be educated from living in rural poverty.

[00:03:37] My own father was sent to the countryside for two years after high school.

[00:03:41]  He was one of the few from this village who returned to the city afterwards and pursued a college education. It turns out that Julian's parents had a similar trajectory.  

[00:03:52]

[00:03:52]

[00:03:52] Julian: [00:03:52] That 16, , my dad was sent to the countryside.

[00:03:55] And so that's how he met my mom. My mom was from the village and, and I was there for seven years, planting rice, right. To the very end of the revolution till Mao's death, 76. And so he was 23.  Um, my dad is from a highly, highly educated family.

[00:04:11]

[00:04:11]Uh, and then, so he knew English. So my, my grandfather, uh, of all people, well, uh, studied at the university of Illinois. Uh, you know, did his masters and everything there. And so, so my, my, my grandfather taught my dad English from a very, very early age.

[00:04:23]   Narration: [00:04:24] It was exceptionally unusual for a Chinese citizen to have received an education abroad during this time.

[00:04:31] Julianne's grandfather being educated in the States meant that Julian's father would also have received some of this rare knowledge from the West and subsequently passed it on to Julian as a child in China, priming him to receive further Western ideas later on.  But of course at that time no one could imagine exactly how this would come to pass

[00:04:50]  Julian: [00:04:52] so it was during that time that, um, PM and square happened. Students dying or the rest of it.

[00:04:58]  Narration: [00:05:00] The massacre of Chinon and square on June 4th, 1989. A tragic event that put China on the front page of international media. Student protests have been held in the weeks prior. They were demonstrating for political reform, demanding, greater freedom and openness to democracy, more accountability and transparency from government officials and greater funding for education. The unrest to disturb the CCP, the Chinese communist party, and the government called for military action to silence it.

[00:05:28] Soldiers and armor tanks rolled down the main road, leading up to Tiananmen square with the instructions to use deadly force. This is where the iconic picture of tank man comes from alone. University student heading off a cue of tanks. Even as a tank's looms, ominously forward towards pointed directly at him, they still tried to steer their way around him. So as to not crush him,

[00:05:50] The student shuffles left then right to place himself squarely in the path of the lead tank. It's a tense moment, but also a heartbreaking one. The terror of the military, turning on its own citizens and the perceptible internal conflict of countrymen against countrymen.  The casualties from the massacre can only be approximated

[00:06:09] previous figures place the death toll at 1000, but newer estimates placed the true number of people killed during the crackdown at 10,000, with many more thousands wounded. The massacre while broadcast to the rest of the world was erased from Chinese history books, like other totalitarian regimes, revising and deleting inconvenient truths came with the party.

[00:06:30]  The Tiananmen square massacre is to this day are with great care omitted from the educational system and violations are treated as heavy offenses. Those entering China as international teachers can sometimes be contractually obligated to keep quiet from talking about the brutal event.

[00:06:48] For many who have lived through this time, The Tiananmen square massacres, or like the ghost of a giant elephant in the room.  

[00:06:54]

[00:06:55] Julian: [00:06:55] So very astonishing event because I was actually very close by to Tam and square where it happened.

[00:07:00] I was literally two blocks away. I remember the gunshots and I remember clearly being very, very puzzled because. School is out and, you know, in China, school is never out right. School, school is out. And I was hearing these pumping sound on the streets that I thought were fire fireworks. So, so I remember very, very clearly asked my grandma, like, how come what's going on?

[00:07:22] There's fireworks on the street. It must be a holiday. I'm not going to school. Right. And the memory got imprinted onto me because, uh, for the next two days, three days, I think it was longer than that. My grandmother never left the house. Then I'll leave the house. Uh, which ended in back in China those days we had no fridge.

[00:07:38] So if you didn't leave the house to buy fresh food, there was no food. So a few things memory better than hunger. So w w we had very little. Well for two days. So I remember that, but that same event, which caught me up in that moment, uh, allowed my dad to come to Canada. So Canada, it was under the Moroni government at that point.

[00:07:57] Yeah. It astonishingly offered some sort of amnesty. I'm not quite sure on the details, but offered some sort of amnesty for any Chinese person trying to adapt. A very different world back then than right now,

[00:08:08]

[00:08:08]

[00:08:10] Narration: [00:08:10] hearing Julian say this was a clarifying moment for me. When the massacre happened, my father was a student abroad in Canada on a year of exchange. He was scheduled to return to China where my mother and I were waiting for him.  But following this brutal and bloody statement from the Chinese government, as to the extent it was willing to go to, to maintain control over its citizens. My father decided that Canada was a safer and better place to raise his family and he sponsored us to join him in Calgary.

[00:08:38] We were fortunate to have been welcomed by Canada with open arms.  Along with the wave of Chinese immigrants. We're also able to leave when we did. To this day, I still see immigrating to Canada and eventually becoming a Canadian citizen as the single most important event in shaping the course of my life.

[00:08:56] Now that doesn't mean it didn't come with its own set of long reaching consequences.  

[00:09:00] Julian: [00:09:02]

[00:09:02] Chinese, within that period who came to Canada, very, very rare. Uh, in, in, in the early nineties, the big wave of immigration didn't happen until much later. So you're, you're very rightfully we belong to a very rare immigrants. And most of us in this very, very unusual cohort came out because of the, of gamma square, uh, June the fourth incident.

[00:09:18] So it's such a different time and the, the conversation around refugees. So back then the Canda was, was. Was founded an honor. It was, it was a privilege to be able to bring people here that was a conversation around that was very different about the conversation about refugees. These days, Moroni was a conservative government, but you tend to even see a liberal government doing anything like that.

[00:09:39] These days,

[00:09:39]Sen: [00:09:39] you know, the circumstances of Canada were different than as well because they, they still needed to grow their population, you know, so they were happy to welcome immigrants, especially if they were educated.

[00:09:49] Julian: [00:09:49] Yeah, that's also absolutely true, but this one was sort of more of a blanket sort of a thing that, you know, if you could

[00:09:54] get out of China at that point, uh, Canada was going to take you, which I'm always grateful for, you know?

[00:09:59]Sen: [00:09:59] Yeah. Me too. Me too.

[00:10:00]    Narration: [00:10:02] The shock of immigration. As Julian explains the global outrage at the atrocity of a government using its military to quell its own protesting citizens became the vehicle through which a wave of diasporic immigraes left China to seek better lives in distant lands. Immigration under these conditions. Isn't exactly ideal,

[00:10:23]many left without a clue as to what they were going to do in the new country. And without speaking the language of the land,

[00:10:28]those of us who came at a young enough age assimilated quickly into the dominant society. Or at least more quickly than our parents could.

[00:10:35]Nevertheless, especially for younger children, the fracturing process of being uprooted from everything you've ever known and suddenly presented with a new reality that you just had to adjust to is nothing short of traumatizing.

[00:10:46] With a host of potential consequences.  

[00:10:48]

[00:10:48]Julian: [00:10:50] And so in Canada, um, I have to say the first, first few years actually weren't bad. It just got worse. And there's a reason I don't talk much about that period until my university, because my memory is a bit of a blank.

[00:11:05]Uh, my memory is a bit of a blank between the ages of 10 and 20 probably. And I have tremendous difficulty linking events or remembering anything. In fact, I mean, we moved a lot. We moved about every two years for cheaper apartments or whatever, and I cannot remember the interiors of any of those apartments.

[00:11:25] And in fact, I cannot remember the order of them, of when we live, where. So there was a place that I thought we lived in when I was very young, but when I finally matched up my story with my parents, and that was actually when I lived there in my late teens, you know, so, and, and in fact, my, the last place I lived at my wife's now, your dad has a much better memory of what it looked like inside there than I did.

[00:11:47] Oh, so I have very, very little recollection.

[00:11:50] Sen: [00:11:50] What do you think is the cause of that? I

[00:11:53] Julian: [00:11:53] think I was very stressed out for a lot of years. Like not a little bit stressed out, like, like quite stressed out. And so, so I mean, that's one of the effects of trauma is that the trauma scrambles time, you can be quite old, but when trauma hits you, you feel like a kid.

[00:12:08] And then the memory gets encoded as a kid memory. Uh, but not as adults, but the facts of it was that my dad did very poorly after he came to Canada, he didn't really work very hard at finding a job. Um, uh, and I think, I mean, clinically, he was probably very, very depressed now that I'm.

[00:12:23] I know that these days fresh and came out in a form of a unfortunately a significant anger. So there was a lot of conflict, uh, at home. Yeah. So you never found a proper employment until our financial circumstances, more or less forced us to open a defender. Which as a common story of many, many Chinese families.

[00:12:43] So  

[00:12:43]Narration: [00:12:45] The language of convenience stores. Immigrants finding their way in the new land, through the operation of a convenience store is a worldwide phenomenon. And the U S especially in New York, you have bodegas and the UK off licensed stores or office

[00:13:00] in Germany. She Betty's or sped coasts. And in Quebec, they're called Anywhere in the world There are immigrants there is the equivalent of a corner shop

[00:13:08]

[00:13:08]I thought about how hard a transition it must've been for Julian's parents and especially his highly educated father to be working at a convenience store. It's again the story of so many immigrants to not have access to the kind of work that they were trained and qualified to do,  and certainly not able to contribute with their full capacities to the society they were living in

[00:13:28]For julian's father things took a turn for the worse

[00:13:32]  Julian: [00:13:33] I tell people it's the ice storm of 98. Uh, I'm not actually sure if it's the eye storm, because my house scrambled, my memory is, you know, it could have been 96, 97.

[00:13:42] Never really talked to my parents about it, what year it was. But my dad had a horrible car accident. Uh, he has the car skid on the ice and he can, uh, he hit a tree apparently. So, yeah. So I saw the car. The memory of the cars is fairly imprinted on my memory. It's. It was like half the size. And, uh, and he was in ICU for a little bit.

[00:14:03] And, uh, he came out not quite the same. So one, it was a very striking memory there, which is that Mia and my dad, he taught me how to play golf, the Chinese game of cool black and white pieces. And he, my dad is quite good at golf a lot better than I ever got. And I remember after the trauma. After he hits himself, we were playing and I realized I was going to be very easily kind to crush him.

[00:14:27] His ability to play, go head badly descended. And I had a pullback. I pulled back and I let him win because I couldn't tolerate winning. Uh, not, not like that, you know? He was a totally different person after the accident. Uh, the violence that was always there, it got much, much worse. Uh, so there were social workers, police, that was the rigmarole.

[00:14:50] And so it it was not a very happy period. We were on welfare for several years after that.  

[00:14:56] Narration: [00:14:56] With Julian's father, his ability to work compromise through this traumatic accident. Julian's mother now had no choice, but to put herself to the test and find a way to provide for the family on her own. Let's not forget that Julian's mother came from the countryside. Unlike Julian's father. She spoke only Chinese and had not had the benefit of higher education as his father did.

[00:15:16] However. Survival demands resourcefulness and ingenuity and julian's mother found a way through  

[00:15:24]Julian: [00:15:24] but my mom amazingly. Good for her. I mean, she's a village woman, so she came to Canada, not knowing the 26 alphabets, but asked her that incident. during the years of welfare, she went off and enrolled in the business school in one of these job retraining centers, uh, learn Microsoft.

[00:15:41] Learn English learn French to this day. I don't know how she did it. You know, over a period of about three to four years when we were on welfare and she found a job, it's pretty amazing. Incredible. So my mom ended up being in the administrator at, at a college for, for many years, which is a crazy thought.

[00:15:58] When you think that semi-literate, you mean Chinese? You know that she's a villager. I mean, it's like we saw 150 years ago. Historical development wrote into my mom's one life.

[00:16:08] Sen: [00:16:08] Yeah. She was just like accelerate, accelerate, accelerate.

[00:16:11]Julian: [00:16:11] Yeah. It was a major role reverse in the family. My, my dad used to be the boss. He was the one with the language skills. He was the one who was supposed to provide, even if he didn't do so clearly. But when was that, there was that totally clear role reversal.

[00:16:25] We actually did much better.

[00:16:26]Sen: [00:16:26] Right. And it was like putting the right person into the right role for the circumstance.

[00:16:30] Julian: [00:16:30] Correct amazingly enough. Well, my memory actually picks up so after we were better financially, so I was probably about 1819. My memory comes back. So, so it must've been less stressful at home.

[00:16:42] And I was doing better. I don't say it much these days, but I did very poorly. Fairly clear why to me, these days to my parents to sit here with distress, I did very, very poorly in school, but once family settled a little bit, I started doing better in school and that they, I think were very, very pleased by that as well.

[00:17:00]   Narration: [00:17:02] The protective mechanisms we develop as children to deal with. Inordinate levels of stress are fascinating. Memory loss is a trauma survival skill that can help a person to cope by allowing them to temporarily forget details of the event until they're ready to process in a more conscious way.

[00:17:19] Julian talking about his memory loss. Maybe wonder how much of my own childhood I might not be remembering if you don't remember what you don't remember. How do you know what you're missing?  

[00:17:30] Sen: [00:17:30] Can you remember anything from those years?

[00:17:34] Julian: [00:17:34] I remember a few significant events, usually on the horrible range of things, uh, and more as, uh, photos then as moving memories. And to this date, I have no clear recollection of the interior's most homesick, very little, sometimes things will trigger off memories, but then the memories disappear.

[00:17:54] And I don't know what came up a little while ago. What

[00:17:59] Sen: [00:17:59] is it like? To be living with such a big gap in the formative years of your child.

[00:18:05] Julian: [00:18:05] As we know, I'm a psychiatrist almost as part of our training, we are in therapy, I'm still in therapy. The strongest word I can find for it is that's very sad of a chunk of my life missing a little bit.

[00:18:17] You know, it was very, very hard. It was important for me to be able to block those things off. I think it speaks to a certain character in me that I was able to block it off. I don't think I would have done well if I didn't, wasn't able to block certain things off, you know, uh, the, is there for a reason, it's not there for, for nothing, you know?

[00:18:35] So, so, so it's sad that I lost big chunks of my life, but I'm pleased that, uh, I could ward off a lot of that pain. the first two, three years. Weren't bad. I have some still have some good memories from those years, mostly of my dad teaching me stuff. He taught me about Tom dynasty poetry.

[00:18:51] He taught me the Analects. So astonishingly enough, I've, I've a reasonably good grasp of classical Chinese, which you don't expect in a kid who came when they're six, you know, and that's from the foundation, even for my Chinese studies these days when I studied it myself. So, so that's something he did very well.

[00:19:05] So that part, I do remember.

[00:19:07]Narration: [00:19:07]  I remembered that when Julian and I were doing our respective science degrees, that he, at the end of his degree, decided to apply for medical school. Not having known his backstory at the time. This didn't surprise me. I figured he was just following the path that most other med school bound Asians I knew were doing.

[00:19:25]it was only a few years later when he told me that he was specializing in psychiatry, that I saw something was different about the way Julian was approaching things. Psychiatry is a field that requires a specific kind of interest in the human condition. And does not present straightforward and easily executable solutions Compared with other branches of medicine that are less existential

[00:19:47]especially taking into account. The fact that there was this big piece of Julian's past locked away somewhere in his mind, this made psychiatry and even more fascinating choice. This was the first time i asked julian the question

[00:20:01]  Sen: [00:20:01] what was it that motivated you to want to get into this field?

[00:20:04] Julian: [00:20:04] That's a very interesting question. So I didn't want to be a doctor. I wasn't entirely conforming a Chinese kid. I did, I did very poorly in high school, as I said, uh, due to pressures from Mary. When I applied to medical school, once the first time I applied, I didn't get him there. They asked me, what would you do if you didn't give him the medicine I've interviewed?

[00:20:22] And I looked at them straight in the eye. I was like, I'd make a fairly good mathematician. Thanks. I'm not sure if that answer helped or hindered my, uh, my application to med school, but anyway, I didn't get it. And so I wanted to be a scientist first and foremost. Uh, I got a degree in biology, but also got a degree in mathematics.

[00:20:42] And so, and I enjoy the heck out of both. And I was doing research and I love the research, the ability to put things together, to see more deeply into a phenomenon than anybody's ever seen before. That is. That's that's a big part of me, you know, but so near the end of university, I was like, what am I going to do?

[00:20:58] And I'm very much like you, I guess I had no idea what to do with myself. Uh, I had no idea, so I, I want to be a scientist, but I realized I really did not want academia. Uh, the pay was poor. I know that sounds crass, but the pay was poor. Chances are low, you know, the stress enormous. So, so near the end of university,

[00:21:18] I took a year off to figure things out, right. I was in China.  at that point. My ideas had changed as young people often do. I, I played a lot of video games. I thought I was going to become a concept artist for a, for a blizzard, the video game company. Uh, and they were hiring straight out of China at that point.

[00:21:31] So I figured I'd go. I spent a year in Nanjing. And, uh, yeah, then had been my girlfriend, uh, already at that point that she really so,  I was on a nice edge. What am I going to do with my life? And she really gave me that little bit of a push to go down. So she was like, just try it.

[00:21:49] Giving us medicine getting another

[00:21:51] Sen: [00:21:51] medicine thing, a try here. It's pretty good.

[00:21:57] Julian: [00:21:57] Yeah. There was actually more like, I'm going to break up with you if you don't find it reasonable career. So, so to be completely so ambivalent that I applied to a single program, right. I applied to one program. and not only that, but I wasn't, I didn't want to give up on my academia hopes.

[00:22:12] So I applied to the MD-PhD, which is. Harder to get it, you know? Um, that was the biggest dicer of my life. Right. Because I had actually no idea. If I was going to like being a doctor, I had never volunteered in the hospital. I had done nothing medically medicine related.

[00:22:27] Sen: [00:22:27] So this is like, this is your version of putting all of your eggs in this basket  

[00:22:31] Julian: [00:22:31] But to my utter astonishment, I loved it. I had no idea I was going to like medicine. And before I got into it and I truly had no idea, I'd never stopped it, dr. Stable, but then I really did like it.

[00:22:44]

[00:22:44]So, so for me, I have to say emit three, um, was actually when I first encountered psychotherapy.  So I come from a traditional Chinese family. Right. I had no idea. Psychotherapy was a thing I did not exist in my, in my concept of things. There was no idea that you could talk to people and regulate your feelings that way.

[00:23:01] This is a very strange idea to me. But then I had bumped into a few extraordinarily. Yeah. Talented therapists. And then I realized  in the therapy room, there was as much intensity as much craziness bouncing off the walls. Is there isn't any operating room because it's very much a seminar concept.

[00:23:18] There's no pill. They're doing your work for you. There's you? Your skills and the pathology that is presenting in front of you. Right. That is cruelly, torturing the patient and destroying the patient's life. And all you got is your training, your reflexes, your ability to think on your feet. They're like try to do something with that.

[00:23:33] I absolutely adore it. And that's what, uh, what for sure. That's what led me to say coach. Also, once I opened up this concept of psychiatric concept, I realized how I applied to myself. How did I apply to my family? How my family and including myself, could have been helped many years ago.

[00:23:49] It didn't happen, but I could do it for a lot of other people, which is why this ambition of taking care of lava, Chinese families came up in me, you know, and it turned out to be a really great fit.

[00:23:59]   Narration: [00:24:00] The way Julian chose psychiatry was also how I eventually chose to become a mental health occupational therapist. Not having had much education in these topics before the first time I encountered psycho-social frameworks to understand the inner workings of the mind and the self. I felt like I had learned a new language to describe the world.

[00:24:19] I learned about different ways to understand the nature of mental and emotional maladies, how they originate, how they're experienced and how they could be treated. Suddenly, it felt like I had a portal of clarity into my own experiences and that of others. And naturally i wanted to use what i learned to help myself and others like me through their own clouds of confusion

[00:24:38]   on the topic of psychosocial frameworks to understand the inner world there was a question that had been burning in my mind to ask julian

[00:24:47] Sen: [00:24:49] given your. Field of knowledge, you know, in both the Eastern and Western traditions. One of the most important questions that has come to my mind is when we think about Asian mental health, and we apply the framework of Western psychology to the things that Asian people experience, whether they're still in their countries in Asia or whether they've immigrated to other countries, does it even make sense to apply that framework to what they're experiencing?

[00:25:15] Because we don't have that same framework in our own culture. When we talk about things  like mood disorders, like bipolar disorder, uh, clinical depression. When we talk about anxiety, when we talk about personality disorders, borderline personality disorder is one of the more common ones do these terms.

[00:25:31] Can they even be applied to people who come from a different cultural background? So

[00:25:35] Julian: [00:25:35] this is a very profound question. It touches on two questions, the difference between East and West and to the degree to which psychiatric illnesses are constructed. I don't have a definite of asset to either if I did, I'd be writing books, deepest questions country, for sure.

[00:25:52] Psychiatric diagnosis are partially constructed. The thing that I know about his PTSD, for example, PTSD is phenomenal. The illness was definitely, there was a huge upsurge in the aftermath, the Vietnam war, uh, and people needed a particular diagnosis. For this constellation of symptoms that people were suffering from, cause they needed to claim a status as veterans.

[00:26:15]Uh, and they needed that stuff from the insurance companies. And there were suffering from a series of symptoms that were not clearly depression, not clearly anxiety. So a term had to be invented for what is actually extremely heterogeneous collection of symptoms linked to the same ideology, trauma, but Asheville extraordinary different.

[00:26:33] If you look at it, The PTSD criteria. It's the one, the worst criteria. And then seven there's like 21 of them, two different people with two, with PTSD to have zero overlap with each other. Right.

[00:26:43] Sen: [00:26:43] Okay. So it's like a catch all term.

[00:26:46] Julian: [00:26:46] It's a very, very much about Patrick. And so you could just see this construction, this diagnosis going on due to sociological forces, uh, they needed such a diagnosis,

[00:26:54]

[00:26:54]  Narration: [00:26:56] julian was talking about how some psychiatric diagnoses like PTSD might be more socially constructed than others. But I wanted to know something more specific to our third culture and immigrant experiences.  

[00:27:09] How does psychiatry a discipline that evolved in the west with roots in western philosophy western history western experiences and western words apply to our asian culture.

[00:27:21] Could a framework that developed in a world with different values and rules, be simply laid over a culture as different as the Asian one and still make sense.

[00:27:30] Or are there aspects to the experience of mental health that are universal and which transcend frameworks, language and cultural reference points.     mental suffering is absolutely, you know, you know, pain or trauma.

[00:27:45] Julian: [00:27:45] Sorrow, uh, you don't need diagnosis to work with. I'll take one of the most classic example of what I think is a commonality between the two cultures. one of the things that, uh, Freud discovered is just how absolutely intensely people are attached to their parents. Right. They have a certain relationship with their parents and this pattern persists outside.

[00:28:07] They have this pattern over and over again with other people. Uh, Chinese super, really noticed that too,     one thing that   Freud, not Freud himself articulate, but psychodynamic and Chinese people have really hit the same conclusion that if you grew up seeing your parents in pain,  one of your desperate wishes or deepest, deepest, right to the course of the things is that you want to make them feel better.

[00:28:27] The kid wants to save the parents. And that can create problems later on, but it just speaks to how much love the kid has for the paradigm. You, the kid grows up seeing the parenting pain. Uh, the sadness is worse than if the parent beat up the kid that sucks. If the parent is a tremendous pain and the kid trusts the save the parent, but cat that's crazy stuff.

[00:28:46] That's intense. And so that sort of dynamic is very, very common to both the East and the West. And I would say that as a sort of, you know, Chinese people caught filial piety has a lot to do with this, this complex. There's the feeling of wanting to take care of your parents, wanting to save them, wanting to relieve them of the horrible pain that you saw a lot of analysts and therapists have very much realized that same thing. So I would say human nature is very similar on both sides, human development, the way that. Before few, had a very deep level about things and people get hurt about different things. It's very, very similar, both sides of divides.

[00:29:21] You just have to have a certain vocabulary to bring out those things at emotions. And, uh, and it's not so different.

[00:29:27] Sen: [00:29:27] And on the topic of vocabulary. Um, we have a lot of vocabulary in Western psychology to describe the psychodynamic phenomena that people go through. Um, do we have the same kind of vocabulary in

[00:29:39] Julian: [00:29:39] Asian cultures?

[00:29:40] Yes, absolutely. It's a very different type. All of psychodynamic and psychology terms deals with the individual what's going on inside here. It's me, myself and I examining me, myself and I, but like we were talking about before, you know, the right unit, uh, of Chinese character, Chinese person. It's not the person.

[00:29:59] It's definitely the family. Right? So, so, so when, when a patient comes to me from Canada, actually the person, but very few Chinese people show up a lot. They usually come in with, with everybody and talking to my Indian friends, you know, it's the same thing in your psychiatry if they come in and the Greek ones.

[00:30:15]  Narration: [00:30:16] Those of us familiar with Asian culture? No, this fact intimately. A family is not a collection of individuals all with their own distinct consciousnesses. Rather the family itself is the unit with the members of the family, each sharing in a group sense of identity. Now this isn't science fiction and it's also not a beehive. It's not like we can hear each other's thoughts and control each other's actions, but it's also not entirely that far from it either.

[00:30:44] In the collective of the family, each person's actions reflected directly on the family and the group together is more important than any individual in the group. The relationships between the members of the group can often take on qualities of being in meshed, inextricably, tied to each other. In a way that to the outside Western world can seem problematic.

[00:31:04] So, how does this all present itself? When an Asian family finds themselves in front of an Asian psychiatrist? Educated in the West, but deeply aware of Asian dynamics.    

[00:31:17] Julian: [00:31:17] And so the vocabulary used to describe things in, in, in Chinese culture is interpersonal, not interpersonal, nothing to me. But between people. So they bring in a family and then I hate you. I know. Why can't you do this? Why can't you do that? I really want the best for you then. Why are you attacking me this or blah, blah, blah, blah, that conversation, which also happens at Western family.

[00:31:40]it's not interrupted and it's not in one person. But it is the language of psychology, uh, in the Chinese culture, it has the language of relationships, language of, of obligations to each other and stuff. And that is how you can talk about how people I feel you don't talk about persons feeling inside how they feel about each other.

[00:31:58] How they feel about each other, how they relate to each other, how they are obligated to each other. And that way is how we can reach out some very, very deep things.

[00:32:07] Sen: [00:32:07] I want to ask you a question about this concept of the, um, the one unit being a family versus the one unit being an individual, and what that means for people in Asian cultures, who.

[00:32:18] Are kind of somewhere in between, you know, people like me where I know that I belong to that family unit, but I'm, I'm like, I'm like already halfway, if not three quarters of the way out of it. And I am firmly planted in the individualist. Um, we have thinking in Western society, but at the same time, I know that there's something else.

[00:32:37] That's that totally routes me to my family unit, even if it's causing me pain and suffering. So what about those people who are not one or the other, so many of the third culture people.

[00:32:48] Julian: [00:32:48] So, so that obviously applies to myself as well. Uh, I don't have a clever answer. Uh, if for each of us it becomes a creative problem that demands a creative and very, very unique solution.

[00:32:58]You know, every human being goes through two individual actions once as, as a toddler. You know, they grow into a certain character and once it's a teenager, they grow into a certain, all immigrants have to do it a third time. Immigration costs for us to individually, but you have to figure out a certain character, forgot a second person to be a third time.

[00:33:15] And that has, that is very, very hard. I don't have a clever answer. My, the way I've. More or less somewhat figured it out is that I know. I know one step ahead. If this is going to work for me or not going to work for me and I take that stuff and I take another step, you know, I'm married and that the Chinese person, uh, I stay in.

[00:33:33] Relatively close contact with my parents, but God forbid, I'll never let them live with me. Uh, you know, they helped me take care of the kid. I cook. They're very, very Chinese food, but you know, what, why talk to patients like even, I think of myself, the vocabulary that regularly comes to my head is the, is the psychodynamic vocabulary.

[00:33:50] It's very much as a compromise and a search for solutions for what's worked for me. You know,

[00:33:54]Sen: [00:33:54] well, well, it's interesting because your notion of what is a creative solution for this, um, mirrors, what Esther Perel says about things. Um, she says, you know, don't think of you things as a problem to be solved, but rather a paradox to be managed and.

[00:34:07] In that way, it's somehow alleviates the responses, stability of having to find the one right path through your suffering and rather think, well,  life is full of these kinds of strange creative challenges that we need to find creative answers to that are constantly changing.

[00:34:22] Julian: [00:34:22] Yeah, exactly. Exactly. Yeah, I've done as much.

[00:34:25]Uh, you know, don't be the old paramount leader of China as much as you know, he was excessive in camera's square. Uh, he, she said that, uh, when he was opening up China's economy, right? There's no road maps. Uh, there's no plan. You try something if it worked. Ah, that's great. Well, that was a nice experiment.

[00:34:41] That's exactly it. Yeah.

[00:34:43]  Narration: [00:34:44] Not surprisingly, there, wasn't an easy answer as to how to balance my drive toward individualism with my roots in collectivism. From what I gathered from Julian, he kind of winged it as he went along, . Which is what I've been doing this whole time, too. You get an idea of the kind of person you'd like to be. What kinds of things you'd like to experience and how you want to engage with the world. You try things out and based on what happens you do the next thing.

[00:35:10]Actually what struck me was that how each of us navigate this balance is actually the most individual expression Nepal.

[00:35:17]even within traditional family and cultural structures, there exists a unique expression of that particular group, which means that the interplay between a certain group and its members exists only in that specific configuration,

[00:35:30] despite the fact that it may seem the same on the outside.

[00:35:33] The relationship I have with my family is different from the relationship that Julian has with his and similarly Julian solution to the creative challenge of being who he is and the context of his family and larger societal culture is going to be quite different from my solution for my own circumstances.

[00:35:51] In a way it's liberating and empowering to remember that there are actually no right answers. Only the ones we create for ourselves.

[00:36:00] But we're not finished. I had more questions for Julian. Tune in for part two of this episode next time on beyond asian