My name is Francis Liu. I'm an emeritus professor in Cultural Psychiatry at UC Davis, and I always tell people that I have presented at every APA annual meeting since 1984, including this year. And I'm happy to present to you the Kung Po Hsu Award Lecture, and to introduce the awardee, Dr. Kenneth Fung. But before he begins his lecture, I wanted to say a little bit about the award, which was first established in 1987. And actually, it was during that time I was the chair of the Committee of Asian American Psychiatrists, and we got it approved by the APA. And we were very, very fortunate to have Dr. Kung Po Hsu, a physician in Taiwan, actually help provide the funding to support this award. And his son, Kung Po Hsu, was an awardee just, I believe, last year or the year before. He's a psychiatrist. So this award was established to recognize an individual who has made a significant contribution towards the understanding, the impact, and importance of Asian cultural heritage in areas relevant to psychiatry. The award also seeks to encourage scholarship and research in culture-specific mental health issues and treatment needs of Asian populations, and to stimulate scientific exchange on transcultural issues. Now, the call for nominations for next year's award that would be delivered at the annual meeting next year closes on August 15. That's the deadline. You could just go to the APA website and search for Kung Po Hsu Award to learn the details. So if you know of someone who deserves to be recognized, please go to the website and follow the instructions. It's basically a cover letter and a CV is all that's really needed. And there's a selection committee that then reviews the award's nominations. I think the person does not need to be a member of APA, nor even a psychiatrist. We've had non-psychiatrists, non-members win this award, so please keep that in mind. So now to introduce Dr. Kenneth Fung. I've known Kenneth for, I think it's about 20 years or so. And Dr. Kenneth Fung is a staff psychiatrist and clinical director of the Asian Initiative in Mental Health Program at the Toronto Western Hospital, the University Health Network. He's a professor and director of global mental health with the Department of Psychiatry, University of Toronto. His research, teaching, and clinical interests include both cultural psychiatry and psychotherapy. He conducts community-based research and projects in stigma, resilience, mental health promotion, trauma, caregivers for children with ASD, immigrant and refugee mental health, and pandemic response. He's recognized as the distinguished fellow of the Canadian Psychiatric Association, fellow of the APA, and fellow of the Association of Contextual Behavioral Science. And I know Kenneth best through our work through the Society for the Study of Psychiatry and Culture. Kenneth was a recent president, and we just had our annual meeting in mid-April in Toronto. So I'm very pleased to present this, the 2024 Kung Po Hsu Award to Dr. Kenneth Fung. So we'll come. Thank you very much. Thank you all for coming to hear me speak. And before I begin, I just want to give a special thanks to Dr. Francis Liu. As you've heard, he's been here since only forever. He is truly a mentor of mentors. So anybody in the field of cultural psychiatry, anybody in the field who is interested in Asian mental health, I think they would all tell you that Francis is one of their icons and mentors. So I just want to thank Dr. Liu. Dr. Liu, I'm very honored to be receiving this award and to be able to share a little bit of my thoughts today on Asian mental health, something that I'm passionate about. Perhaps I can start with title a little bit, because I thought what would be an interesting title to name it? Because if I just say I got an award, yay, thank you, it doesn't sound like a good title. So I thought, yeah, butterfly sounds good. I'm just wondering, how does butterfly have anything to do with Asian or Asian mental health? Would people have any idea? Madame Butterfly. Yeah, that's one of my first thoughts. Yeah. Oh, it's a Chinese story about butterfly lovers. A Chinese story about butterfly lovers? Yeah, it's a legend. It's a legend of the butterfly lovers, yes. So Madame Butterfly, butterfly lovers, yeah, those two did come to my mind, too. Anything else? If not, then perhaps as we talk further, we can continue to see if you can find meaning behind the title Butterfly Kaleidoscope or Kaleidoscope Butterfly. It could be that kaleidoscope, it's like a mishmash of different things. So it will be some of my musings of different ideas. But, yeah, certainly, I think butterfly is such a helpful metaphor for many things, but also in Asian culture. Some of you might know this particular story. Do people know this particular story? Do you know this particular story? It's about the dream. It's about a Chinese philosopher having a dream one day of being a butterfly. And as I think some of you are starting to nod your head to recognize it, and then he woke up. And he was saying that, am I still in a dream? Like, how do I know that I'm not a butterfly who's now having a dream as a philosopher, right? So this becomes the classic quintessential philosophical questions about reality, right? Are we all in a dream? And, you know, are you only dreaming that you're here listening to me? It could be, right? I need to pinch myself to see if I'm in a dream. But I think that this, I think starts off this idea about who we are and what is reality. So when I think to myself, I'm speaking to you now as an Asian, well, first of all, when I woke up this morning from bed, because I heard this also from a black person a little while ago, about a month ago, and really inspired me to think about this. When we talk about cultural issues, ethnic issues, it's very interesting. I find it very interesting. Because when I woke up this morning, I did think to myself, what is reality? I did think to myself, am I awake yet? You know, usually we do that every morning. What I didn't think to myself was, do I wake up as an Asian or not? And this identity of being Asian, am I authentically here speaking to you as an Asian? Am I a real Asian, real Chinese? Can I speak with authority about being Asian and about Asian mental health? I think these are important and interesting questions. Because sometimes it's also a challenge too, right? For those of us who are in cultural psychiatry, my first 5, 10, 15, 20 years, I'm even afraid to say I'm in cultural psychiatry, because what do I know about culture? What do I know about being Asian? Did I wake up this morning and did I think of myself as an Asian? Do I feel like I qualify? I speak on behalf of Asians. And do we go about our lives thinking that we are Asian? Because it's a very complex relationship. I heard from a colleague who is black and said, yes, I have lived experience as a black person. Discrimination is a real issue. But when I woke up this morning, I look in the mirror, I wasn't thinking that I'm being black today. And same, like when we wake up, how do we relate to our cultural identity? I think this is one of the questions that I would talk about as we go on, about both the importance of acknowledging cultural identity, the potential caveats to that, the challenges of doing that, but also the beauty of doing that. And all come from, I think, Drang-Chi's dream. So trying to find and defining Asian, and what it is about Asian mental health and Asian culture, what do you think about as you think about Asian in the States? Most people think you're Asian. Don't you? Yes. This was me last night. A selfie. Right? Or maybe it's this. I can't stand this character, by the way, but here is Asian representation on TV from Two Broke Girls. Or this. This is Cloud Atlas. I don't know if you've heard of Cloud Atlas. In many levels, it's about dreams or different worlds colliding, but this is a representation of what Asian looks like. Actually, by the way, he's not Asian. And this was a major controversy. You can see the prosthetic is there to convert a non-Asian to Asian, by the way. You can have your thoughts about that. If this was a black face, it would not be permissible. But this is Asian. Just throwing it out there. Asian can look like this in Hollywood. He's not Asian again. But if you look at Go to Asia, maybe Asians actually look like this now. That's what happens when you go to Asia. I'm also president of a dance company. This is a wild dance from a Chinese traditional tribe, and this is what Asian looks like, too, traditionally. The distinctive feature of the dance is to dance with their hair. And you thought that punk rock invented that, or Bon Jovi. But it all came from China. Before Bon Jovi starts having long hair. And then Asians. Who are Asians? When we talk about Asians, are we talking about Confucius? Are we talking about Christian Asians? How about Buddhist Asians? Are we talking about different classes of Asians from different educated classes? Are we talking about the politics in Asia? Are we talking about the values of collectivism and filial piety? I think as we think about the impact and importance of thinking about Asian culture and mental health, we can think about all these diversity of Asians. Again, I don't think we need to narrow down on one, but think of the kaleidoscope of what Asian values, Asian culture, Asian heritage means to really expand our vision of Asians. So I'll give you another example. This is, do you recognize this is from which movie? Departed, yeah. So this is one of Hong Kong's clean to fame, because it was a Hong Kong original script movie of 無間道 is the Cantonese movie title. And it really features two famous Hong Kong stars. It was completely redone in Hollywood called Departed. And it won Academy Awards and things. But it was a shot by shot remake of an original Hong Kong film. But we can see cultural differences even kind of within that in terms of the two heroes. It's I think Leonardo DiCaprio and Matt Damon and Jack Nicholson, stars in it. So it's a very good movie. You should see it. But you can see that the Asian culture was recast as I think mafia. Why? I don't know why, but it's recast into mafia. That's how we retell the story. But more recently, we can see finally an Asian superhero. And I think it's great. The same actor actually appeared in the lower left-hand corner, as is in the upper left-hand corner. For you who didn't know, it's the same Chinese actor is now a Marvel superhero being the quintessential you-can-never-please-your-Asian-father piece. And I'm still the same, trying to please my own Asian father. And yeah, I think what I'd like to share with you, and I hope it's okay, is some of these personalized observations. And then I'll maybe launch into a more formal presentation if it's okay. Because I feel that some of this tells a little bit about where I came from. And where did I come from is always the question that I start off with this butterfly dream. I came from this place, or I grew up from this place, which is Hong Kong at nighttime. So it's pretty beautiful. And it's a dated picture because it reflects as a child looking at the Hong Kong harbor. And this is where I came from. And this is what I kind of look like in the Hong Kong family. And when I was small, again, I didn't think that I was Asian because everyone just was Asian around me. There wasn't anything special to be Asian when you grow up in Asia. But what I think impacted me lifelong, maybe as a psychiatrist, is the exposure to Asian culture. Again, I didn't think of it as Asian culture. I thought it was the culture. At that time, quite influential was the beginning of Canton Pop. And the god of Canton Pop is Hoi Kwan Kee. I don't know if anybody has heard of him. Raise your hand. Oh, good. Like three people. Yeah. Anyways, he's like the godfather of Canton Pop. And we share the same birthday. That's why he became my idol. Yeah, and we share the same sense of humor, really. He's brilliant. But then so am I. But I remember when I was small, one of my favorite songs of all time, you can see me becoming him, was this. And this is one of his quintessential songs, that whenever I'm down or whenever I have a depressed patient, I sing to my patient. And this is how we do Asian mental health, by the way. We draw from the culture. The god of Canton Pop. And he said in this quintessential song, if something in life is meant to be, it will happen. If something in life isn't meant to be, you can't really force it. And this, can you believe this is actually a pop song? But yeah, it was one of the most popular pop songs because it talks about Asian philosophy. And in interviews, he does talk about that. He writes pop songs that are poppy. He writes pop songs that are like butterfly lovers, like love songs. But he also deliberately writes songs that are philosophical, based on the fact that he was trained also in psychology and philosophy. So you can see that the Chinese culture is also, the pop culture is also kind of just the way we think. So here we sing Bon Jovi, living on a prayer. There we talk about acceptance and life and faith. Another really huge pop song at the time, which I think it's very helpful in looking at self and self-psychology and self as context in acceptance and commitment therapy, which I'll get into later, is this song. The song's title is called Ask Me. I don't know if you've heard of it. But the whole question of the song is about who am I again, like when you wake up from a dream, like ask me who I am. Ask me why I'm happy. Ask me why I suffer in life. I can only smilingly reply with a single phrase. I'm me. It's, again, very simple but deeply philosophical, that I am me but not defined by my experience. And I think that this is something that's important that we carry forth in our work and looking at how Asian philosophy can begin to inform what we do in psychotherapy and how we look about life. I can sing for you, but that would be a karaoke session in another Asian culture. But this is the environment I grew up in. If you look at the upper right-hand corner, it's like a quintessential Hong Kong with a ton of signs that lights up at night. And on the bottom right-hand, it's my old school in Hong Kong. It's a famous school. It's a Catholic school. And what happened to me is how did I end up here and what happened to you is I immigrated to Canada, to this environment. Ooh, yeah. So I went from that to this. And, yeah, before I came, you know, all my friends thought I was going to go to a developed country. When I came here, and I don't think see things this way anymore, but I just recently had a patient who came from Hong Kong because of other politics, and she was just saying, how backwards is this place in Toronto, Canada? And I start to remember, yeah, that's kind of like what I felt when I landed in Canada. And it was like, can you imagine, like, being in a very vibrant kind of city at that time where there's a confluence of East and West culture and a much more calmer place, I would say, in Toronto. So it's definitely a culture shock to kind of try to learn a new language. My mother is a nurse, so in the health profession, my father works for the government in occupational hygiene, so also in kind of health-related field. They all have their struggles to, you know, get work experience in Canada, my mom having to retake nursing exams and all of this. So those immigrant story and trying to understand what to do when you're in the snow or when you're buried in the snow, try to understand, then, how come the streetcar is so slow? How come we still have streetcar? How come the subway is so slow? All of those things. But there we are. And for me, as a child, it also was interesting because those are my childhood. This is my childhood. I was just told that this is an irrelevant slide to show at the APA conference, but I decided to. Yeah, my colleague said, are you sure you want to show this slide in an academic presentation? But there, it's my kind of cultural roots again. And when I came here, so these are my childhood kind of heroes as a child. Like I grew up with kind of these heroes. I don't know if anybody recognized these characters, but actually, it's actually the influence of Japanese culture at the time. And Japanese culture at the time was influenced post-World War II. And it influenced a lot of their thinking. So when they have themes of kids' shows, it does kind of talk about war, like Gundam, but in kind of a serious way about the philosophy of war and what happens to mankind during war and how the problems of it. The upper left-hand corner, you can see it's kind of like an insect man, but it really talks about, again, radiation and how it kind of, you can think about Hiroshima, what happened, right? So the consciousness of radiation and what happens to nature, but then also the power of nature and man and the struggle between, so all of this, right? And then the Doraemon, of course. Future robot, looking forward to the future. So these were like, yeah. When I came here, what do kids here watch? I watch what we watch here. It's the American dream. It's about He-Man by the power of Grayskull and how to be a real American hero, G.I. Joe. So again, it's kind of a cultural shift of values you can see as kids, and we can start to think about our impact on our Asian youth and the different, again, the differences of where we kind of grow up and does it influence us culturally how we see things? Yeah, and what it means even to be masculine, what it means to be a hero, and what is our place in the world? And the hero being G.I. Joe versus actually the poor effects of war, unless you fight in a cool Gundam, mobile suit. But I think it starts to think of, I think we can think about the differences in cultural worldview, but this is just the beginning. And because what I've experienced through is this kind of childhood kaleidoscope, I guess, of different values. When I first came here, I tried to be as Canadian, North American as possible. I was trying to learn English. I was trying to forget being Chinese. I was actively trying to forget the Chinese language because it got in the way. There was this, I told my parents one day that we should not speak Chinese at home because it gets into my way of trying to be as English as possible. Of course, what I've experienced is outlined in this kind of racial, cultural identity development model that a lot of Asian Americans grow up here would kind of identify with. In fact, we can be here to talk about the black identity development model or the Hispanic identity development model. When we grow up here, there is just kind of like when you wake up from a dream, you don't think of yourself being Hispanic or black or Asian, especially when you're a kid, you think of yourself as being, I'm part of the Greek gang. I'm just part of the group. This idea of conformity of I'm just an average American or Canadian, it's the driving overarching pressure, if you will, it's an invisible pressure that we're born into. It's why black kids prefer white dolls over black dolls. Our heroes are white. As I just talked about, when I look in the mirror, I see myself as He-Man if I strip myself naked. That's the way we see ourselves, right? So until there's a dissonance, a dissonance is when you encounter, you recognize that maybe when you wake up and you look in the mirror, other people don't look at you as being white or you encounter racism or you encounter that you are actually different from others. So when you take your lunch to school and other people have different thoughts about what you're eating. So those kinds of dissonance usually then lead to this resistance immersion stage, introspection stage, where you become more like finding your roots, finding your culture and I went through that phase of going to karaoke, reading Chinese books. Thanks to my friends who reintroduced me to that, watching Chinese movies and kind of reconnect with some of your own cultural roots, which is so important and then in an ideal setting, you become more integrative. You can start to pull different things together and this idea of acculturation, like meeting and kaleidoscope of different cultures, it's described by a Canadian, Barry, as this is the Barry's acculturative model. It's a little different from the very classic acculturation model in the States. This is kind of the Canadian-US distinction, at least historically, because historically, early cultural psychiatrists or Asian-American writers would talk about being American on the one hand, being Asian on the other hand, being Asian-American as kind of like in the middle and it was conceptualized that eventually with enough generations, you'll become 100% true American hero. You'll move from bicultural towards 100% American. So that is what we call a uni-dimension approach to acculturation and in Barry's model, we talk more about a bi-dimensional, which means there's this idea, just like from the last slide about integration, the idea that you can be both 100% Chinese and 100% American or Canadian too. Like that is possible. It is not like 50-50, 60-40, 70-30, if that makes sense. And I think this is an important concept. I think now most of us are moving towards this model rather than saying that we're trying to, because that's kind of what happened to the indigenous, breed the native out of the Indian through residential schools and education system. By valuing traditional cultures of different kind, perhaps we can move towards more integration. So the idea is that people can get assimilated, kind of like Borg, absorb into mainstream and forget about your heritage or people can separate themselves and see themselves as distinct and that can occur if there's enough of what we call an ethnic enclave for you to thrive. And then there are those who are marginalized, the immigrants who feel like they are losing touch with the culture, but they can't fit in. And we know from a mental health research that actually that group does the worst, people who feel marginalized. So that group would deserve most attention. But you can see that what's recognized is that the green, you see these strategies, it sounds as if it's voluntary, but it's not completely voluntary. Because in fact, it's always an interaction between an individual and the environment. So you can see the orange is what we do, what we can do in terms of providing an environment that supports different kinds of acculturation. In other words, if a country has policies that encourage multiculturalism, like Canada officially, then there's more possibility of this integration happening. If the policy is one of more melting pot philosophically, which is, you can think about, especially like France, quintessential, and actually US falls a little bit more on the melting pot than multiculturalism, there's a higher pressure to become assimilated, that the pressure is towards that direction. Of course, segregation is what happens in apartheid when people are just separated. It's not that the person wishing to be separated, but we are actually segregating people. And again, of course, we can exclude people, like a certain time when certain religious groups are excluded from certain countries, for instance. So we can see that there is an interaction between policies at a national level, but even at various levels, and what we can do about it, and how we should think about how we accept immigrants. To what extent do we celebrate different cultures? I think we can start to ponder about that. And now, about my kind of journey into cultural psychiatry, I start with this story, because I was PGY2 when this occurred. In PGY2, which is the second year of residency in Canada, I was in a round in an inpatient ward, and there was a South Asian person, a man, he was admitted for eating disorder. So this is highly unusual for multiple reasons. He's Asian, minoritized, but most importantly, he's a man, and he's presenting with eating disorder. So how rare is that? So I think we all are a little bit like, wow, this is gonna be a strange case. And so we round on him. And the nurse was kind of reporting, this person with a strange case must have deep psychopathology. We think he has a personality disorder. That's why he's so strange. And we said, why? And the nurse said, well, he's making unreasonable requests. He wouldn't drink the ice water we give him. He demanded boiled water, especially cooled boiled water. What the hell is that? And I said, well, you know, culturally. So this starts my journey into cultural psychiatry after I find out that my grade was downgraded because of that comment, actually. And I asked the supervisor why, and he cited this example. And he said that sometimes you're a team player, but sometimes you just collude with your patients around their psychopathology. So this is, I think, an example to me about how culture is in our everyday life, but again, is invisible, and patients are not getting the best care. And if you stand up for it, you might even get flak for it. That's my early lesson in PGY2. So fast forward a little bit. We, I essentially founded the Asian Initiative in Mental Health Clinic. As you heard, in 2000, basically when I graduated, I had an opportunity. I had other supervisors which were more sympathetic about Asians and culture and cultural differences in how I could serve. And I think that this is really needed all these years later. I have to say that I'm very happy that about this program, I think it's very important. Only about every two years, someone from the hospital would say to me, it's nice you have this program, but I wonder if it's still needed, or I wonder if this model of trying to provide cultural care, it's already outdated. Maybe it will work 20 years ago, but these days, do we still need anything specific for cultural, do we still need it? And it's a hard question to answer because I would say, of course. I would say, of course. We know that the healthy immigrant effect, we all know about the healthy immigrant effect. This is done in Canada to review some of the literature. The healthy immigrant effect, for example, is that we take the best as immigrants to North America, and we basically, because you have to be healthy to be an immigrant, you have to pass all these exams, you have to be healthier than the norm, but this healthy immigrant effect is found in which that in their physical health, as well as mental health, people deteriorate after they move to Canada and U.S. They catch down to the general population, and then they're worse off eventually than the general population. This is from Ontario population data, and this is looking at inpatient psychiatric admissions that the Chinese, and Salvation, but especially the Chinese, had higher involuntary admissions, are more violent than the average Canadian. This completely shocked and surprised me because I thought that we were all well-behaved. I didn't know that we were more Bruce Lee-like when we were being restrained. I had no idea that was true. We were more psychotic. So, in fact, I think whenever I present this data, people are shocked, including Chinese themselves, because we don't think that we need it, but, in fact, if you look at different ethnic groups again from major data from different groups comparing whites and Salvation and black, Chinese people have the lowest sense of belonging, 50%. I talked to many Chinese. It doesn't matter how many generations you're here. You still get asked, where are you from? It's what we call the perpetual foreigner syndrome. It's just part of waking up again. You don't think of yourself as Asian, but everyone sees you as Asian. It's kind of one of those things that you might not realize it. This continues to be an issue in the second generation as well. It's one of those things that, if you look at a lot of this data, Chinese actually have worse self-rated mental health, but usually they are least diagnosed. So, if you look at the diagnosis, they're usually least diagnosed, least fitting criteria for MDD, but if they rate their actual mental health, it's actually worse than other ethnic groups. It's a very interesting pattern. We can have a lot of discussion about why that is, but I think all of this is to say that it's very important to promote cultural competence, and this has been my kind of passion along with other cultural psychiatrists is to promote the idea that, in a healthcare system, if we really want to serve the diverse population, we need cultural competence. Clinical competence is not enough, that cultural competence, which is to take culture into account. If we look at what Klu Klan has said, and his quote is that, "'Every man in certain respects is like all other men, "'like some other men, and like no other man.'" He said this in 1962. You know, back when there was only men. But. But the idea is that if we look at all human beings, of course, there's like the universal in us, and that's the bread and butter of psychiatry. We have one DSM. In some ways, there are a lot of universals. Of course, we all do psychotherapy. You do very individual care. You listen to the person's childhood story. I force you to listen to my childhood story. So we then come to understand the individual, but somewhere in between those two, you can pick out there's a cultural layer. And this is where cultural competence lies, is to what extent, yeah, you can see that you bleed too, yes. And to what extent that you go, yeah, you have your particular life story, yeah, but. And yet there's a cultural group that you belong to. And that does influence the way you think, the way you feel, the way you see the world. And maybe taking that into account into care is helpful. Usually at this stage, someone would say, but cultural competence is impossible because there are so many cultures. How can anybody know all those cultures? Just like someone would say to me, how can you have a Chinese program? That doesn't make sense because then I'm gonna have to have 100 programs for different ethnic groups. Instead, we should just have one system. I get that all the time. Even when I do a research study, we talk about how we can look at the different diversity issues. Researcher would say, we can't do that. We can't have so many different groups. Just have one group. Maybe throw in a diversity variable. This actually happened last month. It's not like, and with a diversity researcher, that person thought that we can have a white group and then we can have a diverse group. What's a diverse group? Yeah, we can throw in like the immigrants, like the black, the Asians. That would be the diverse group. So we have a group tailored for diversity and then the normal group, which is like the white group. Does that sound, you know, that sounds more feasible than have, you know, a black group or Asian group? Again, there's a lot of tension here. And in cultural competence, in cultural psychiatry, we can indeed think about this. We can think about there's generic cultural competence. Yes, we can increase the mainstream system to take better care of people of diverse cultures, but there can probably be room for a specific cultural programming too. Just getting back to this idea, right? Because, can I say to you that why should there be so many different kinds of restaurants? Just have one McDonald's. Can have Asian, jerk chicken. There you go, we are culturally sensitive. Just one-stop shop, right? So we see problems with that, right? So if we see problems with that in food, you know, why don't we see that in psychiatry? Why is it so foreign to say that, yeah, we need to study culture and think about how to provide better care for different groups, right? So I think that there's room for kind of both. And the DSM, the Outline for Cultural Formulation, is a way to start to talk about a generic way, but also encourage people to think about specific cultural differences. And cultural competence then can lie in different levels. So we can talk about individual cultural competence clinically, but we can also talk about programmatically. We can start to devise programs that's more culturally competent. And we can talk about, just like I said, policies. Societal policies that can encourage more diversity, more integration. And I'm just gonna give you one example of a cultural competence framework at a institutional level based on some of the work we did in providing cultural competence consultation in an institution, and we outlined some of the areas that we can work on. In other words, there can be a method, rather than saying there's no way, it's too hard. Sometimes that's the answer. Too hard, it's just too hard. But there can be a way of helping institutions look at different areas to work on this idea of cultural competence at an institutional level. I'll give you another example of cultural incompetence at my institution. You can see here, what do you think you're seeing? Talk about food, I just talk about food. I talk about food a lot because I'm Asian. But this is a made up Asian lunchbox. I think Asian lunchboxes are interesting. It causes kids a lot of bullying. I experienced that in school when you bring in something. But yeah, but this story is about, again, in my hospital. I just told you I have an Asian program. So this involves like a lunch story. We have a staff room, a staff room. And so apparently one day, a manager asked me to come to her office. I said, okay. And she said, you know, you have your Asian program and you have staff there. I've received complaints by staff in the lunchroom. I said, oh, it's gonna be one of those childhood flashback, right? Is it about the food smell, right? You know, that kind of thing. It was actually this. It was saying that some staff come to me with some concern that your staff was sitting around having lunch, talking to each other in Chinese. I said, oh, really? They what? And she goes, I know. Of course, it's a free country, but I would recommend them to go to their office, eat lunch, and speak Chinese in their own office. Because we don't want to make other staff feel uncomfortable. Because they couldn't understand what they were saying. They were smiling, laughing, having good times. Like, so suspicious. So this is just an example. I don't know how many agree with that. And she even said, you know, I'm an immigrant too. Like, I know the struggle. That's why when I sit in the bus, I make sure I speak English. So this is the manager of a community mental health and diversity program. And her thought. Just give you one example of the kind of thing that goes on. I end up calling the hospital human rights to verify that we are indeed allowed to speak Chinese. Especially if we're on a break. No, I was told that. I was told that there was labor law. That if we were interfacing with English-speaking patients, we are required to speak English. But if we're on a break, we are free to speak your other language. These are the things that you don't really think about. Food, language, boiled water. Things that you just kind of think that this is just the way things are. To get back to the norm and what some of this is, you know, it can be perceived as discrimination. And here I will segue to a little bit about discrimination. Discrimination is a topic in an Asian mental health talk. Something that we usually do not talk about. Because I've been talking about Asian mental health, something like this, for like 20 years. And for the last 17 years, I never had one slide about discrimination. You know, that was before the pandemic. Why? Because people are not interested in hearing about discrimination with Asians. It just isn't a thing that's usually talked about in Asian mental health talk. I don't know. You must have been to Asian mental health talk. How often do you hear about discrimination against Asians? It's not a thing. Is it? Some people are nodding. Yes, it is. So I started to talk about it only because of the pandemic. Because then suddenly people ask me, yeah, talk about Asian mental health again, but this time talk about discrimination. And I was thinking, wow, I did that for 17 years. Now I have to develop a new slide on Asian discrimination. But yeah, it didn't take long to know that Asian discrimination started before Canada was born. Certainly in Canada, the import of Chinese to build a railway, which built the country, the same here in the States, discrimination started before the country was a country, basically. And one Chinese worker died for every mile of track that's laid. It's not something that I learned when I was in grade seven in the Canadian elementary school because I only learned how amazing the tracks were and bringing the whole country together and all that, make Canada and U.S. possible. But yeah, Chinese were brought over to North America often then as expandable labor as assigned the most dangerous task, you know, blasting mines and open up the Rocky Mountains. And that's why there was such high casualty. And to prevent Chinese from thriving, there's the Chinese hat tax, followed only by a better legislation called the Chinese Exclusion Act, which is one of the unique acts of its kind, excluding specifically an ethnic race. And yeah, so the Chinese Exclusion Act in Canada was enacted, I think it only stopped at around 1940-something, basically when Canada had to enter United Nations. And it can't, one of those things was like this. And so it kind of gave up this reluctantly to enter United Nations. But that's the long history of this. In other words, Chinese discrimination didn't start yesterday. In our Canadian history books, we worship John A. Macdonald. He's our first prime minister who pulled the country together. But he's also one who said that Chinese should never be allowed to vote and tame the system because they're like dogs. So why would we let them vote in Canada? But this is the legacy that we don't really necessarily learn about. But actually, racism always has existed. This is just to say. But why don't we hear about it? Why don't even most Chinese people acknowledge it? It's because of the model minority. Have you heard of it? The myth of the model minority. That is to say that discrimination is a black issue. It's not an Asian issue. The idea is that whites are on top and blacks are on the bottom. But Asians, because of their hard work, they're able to pull themselves up to the middle. And this just shows how fair North America is, the American dream. If you work hard enough, you can climb up to be whites. If you are not lazy like the blacks. Look at the Asians. So this is the myth of the model minority. We call it a myth because it's not true. If we look at a lot of parameters, Asians, I just told you, have lots of inequities and disparities as well as discrimination. But even Asians themselves are apologetic when they talk about discrimination. It's a very interesting mindset because once I start talking about Asian discrimination, I was then asked to go to some government employee and talk. So many Asians came out and said, this happened to me in school, that happened to me at work. They all thought that they are not supposed to talk about discrimination because they are being sensitive, because blacks have it worse. So why should Asians complain? They all felt like they were too... I don't know how many Asians in the room identify with that, but so many Asians I've talked to since I talk about this, they all came out, they cried, they talked about, yes, discrimination impact on me, but they always thought it's like them being just overly sensitive. And this is the problem with the myth of model and minority. It actually does not advance social justice. It actually pits one minority group against the others. It's made for black people to feel worse. It's made for Asian people to not complain. And so it is something that now has been increasingly recognized as not a good thing, put it this way. And it's something that we need to recognize and give voice out to. Again, because if you look at all kinds of physical health, there's always disparities. Even physical health among Asians. I'm part of the Federation of Chinese American Chinese Medical Societies. And one of our mission is to increase awareness of just health disparities facing Asians that are not acknowledged in addition to mental health. And of course, when the pandemic happens, it gives legitimacy to talk about anti-Asian discrimination. Unfortunately, it's just becoming more blatant. This is a national kind of survey in Canada which basically when the first pandemic outbroke, it's like 50% of the population will encounter a direct discrimination based on the pandemic. So that was just a shock. Did it get better? The answer is no. Because follow-up study has shown that anti-Asian discrimination just got worse over time, more extensive, involves more Asian groups. And this is how it progressed. And this is a study showing the impact of anti-Asian discrimination on young people, young Americans in the U.S. And first, 60%, even before the pandemic, these are young Asian Americans reporting having experienced harassment even before the pandemic. And of course, they feel less safe after the pandemic and the depression has only increased. So it highlights the invisibility of this issue, even among young people. Discrimination is insidious. It can be structural, it can be interpersonal, but it can also be intrapersonal, meaning internalized. And there is also studies around Asian discrimination that even subtle ones can do as much harm as overt ones. Because, as I said, people are made to left with being gaslighted, like they're being told, you're just too sensitive, you're kind of like, you actually have thicker skin, right? So this actually makes the distress worse because they don't feel that they have the ability to have that moral outrage about discrimination. So then it can have this direct and indirect impact on health, but a lot of it, structurally, it's through social determinants of health. There is such thing as called the bamboo ceiling. Have you heard of that? Yes. The bamboo ceiling, it's kind of like the glass ceiling for women, you know? You can get to a certain place, but Asians are not seen as good leaders, for example, or trusted leaders. So that's why in many settings, including in healthcare settings, that there is a disproportionate of Asians being good workers, but Asians who are outspoken, they're seen as being actually non-Asian for being so outspoken. Why are you complaining so much, right? And so it's kind of that bamboo ceiling that many people experience. There's also intersectionality. We need to acknowledge that if you're a woman, if you're gay, if you're minoritized for other issues, they all intersect, and that certainly applies to Asians as well. And as we said, the effects of discrimination continues on with the second generations. And so this is from a report on anti-Asian discrimination. It was a national kind of forum that we came together during the pandemic, and there was a specific section on health that I was kind of in charge of creating a forum, and we talked about some of the things that we need to change on a systemic level if we are to make some inroads towards anti-Asian discrimination. And this is a documentary that talks about both anti-Asian discrimination but also about allyship, about how allyship can be important. That is, it's not like we're saying that all white people are bad or evil. This is actually a story about allyship, about how communities can come together to help. And another area where perhaps there's a lot of discrimination and becoming a focus during the pandemic includes the Chinatown. It's very affected. And I became involved in another project with an architect who talks about reimagining Chinatown. Chinatown is, you know, we have Chinatown everywhere. Have you visited the Chinatown in New York? What do you think about when you think about Chinatown? Good food. Great, great. So during COVID, a lot of Chinatown were hit hard, and there are also documentary films on Chinatown that also go through various kinds of struggles too with losing touch with the culture, the newer generation, not feeling like Chinatown is a thing. In addition to possibly good food, other people think of it as backwards or outdated or dirty or crime-ridden or infectious, right? So there's good positive things about it, but there are also negative connotations. Some of it is external pressure to actually many Chinatown being attacked by just developers wanting land, and there's a documentary about that, how Chinese people are being squeezed out by developers who just want to redevelop it. And there's also internalized shame on the younger generation, like, do I really want to be seen in Chinatown, or do I just want to be part of, again, the norm? So I think it's an interesting time to think about that. But if we look deeply in the Chinese culture, there's a lot of misconceptions about it. And how I first got into some research about it was my master thesis about alexithymia in the Chinese culture, talked about negative connotations with Chinese. Do you know what alexithymia is? Yeah, some people know. So alexithymia, it comes from psychoanalysis, the idea that there are certain people who are not in touch with their emotions, and they tend to externalize things. So it's thought that people who are more primitive are alexithymic because they don't have the language, they don't know what they're feeling, and they are externalizing things. So they're saying they have a headache instead of their distress. And so do you know who is thought to be alexithymic? Chinese. So some cultural psychiatry textbook actually says, you know how Asians are, they are a little bit less advanced. So whereas more advanced race, like white people, are psychologized, meaning that they can express the distress in a healthy psychological way, Asians tend to somatize because they are more primitive. They lack the emotional awareness, they lack EQ, they lack the emotional description of it. So my master thesis was about alexithymia in the Chinese population, just to see if the scale works. So if you're interested, I can talk to you about alexithymia. It's also Toronto's pride and joy because we have the Toronto alexithymia scale, 20 items, very famous. And I work with the alexithymia expert. And basically I found that, guess what, Chinese people are not alexithymic, we also have emotions too. But it's kind of interesting because one of the hypotheses, well, I'll just show you, this is from my thesis work, the Chinese alexithymic scale. What is very interesting is that the acculturation scale, the Vancouver Index of Acculturation, we found that the more Chinese you are, actually the less alexithymic you are. Yeah, it's actually the opposite of what is expected. One of my supervisors didn't really believe in this. He thought it was probably an error because he just couldn't believe that more identification with being Chinese means you're more emotionally in tune. Actually, one of my other supervisors says, I don't know about this idea that Asians are so empathic and so collectivistic. Look at what Japanese did in World War II. That was the response. Again, there's just some of these ideas about culture and how we internalize certain stereotypes about Asians not being emotional. Because one of the early hypotheses, by the way, for those who study, is called the lexicon hypothesis. That is, if you want to see how culturally in tune a culture is with emotions, you study the dictionary. What was found is something like Chinese lacks a lot of emotional words compared to English. There are so many English words that are emotions, but in Chinese, technically, no. But you know what? That's only because people didn't really know how to study Chinese properly. I was talking to other Chinese people. In fact, the Chinese have very poetic ways of expressing their feelings. It's just that it's not going to be captured in one single word. So that's just an example of problems of cultural research if you don't understand the culture and you're trying to analyze one word. I thought it would be interesting just to show off some Chinese. I'm just wondering if this means anything to anybody. Can you see any rich cultural ideas here? Anybody? Just testing your Chinese knowledge or Chinese-Cantonese knowledge. Anybody have any idea? Yeah? Yeah, what does that mean? See? Did you hear that? So this is just kind of an example of the richness of the Chinese language. He said that 7788, what that means is that, you know, you've done most of the stuff. So to express that I've done most of the stuff, like, yeah, I've talked about most of my slides, but that's not true. I'm just beginning. But that would be called 7788, right? So this is just to show you the richness of it. And I'll just tell you the rest just so you can come away from this talk and say you learned some Chinese. 7788 means, you know, I've done most of it. 15110, sometimes you say it as an expression, saying I want you to tell me everything. Like if you want your client, your patient to tell me everything, you can say, I want you to tell me all the details, one and five and one and ten. So just kind of don't skip the details. Like tell me the story. 1516, what is that? I'm not going to test your Chinese. Michael, you should know that, right? Francis, you should know that, right? No, 1516, it describes this kind of anxious state, like should I do this or should I not do this? That's called 1516. You can see. Oh. Yes. How do you feel about that? 1516 about it. You would literally say that because it really richly expressed you're not sure. Is it 15 or is it 16, right? So is my lecture great or is it excellent? Yeah, 1516 is either great or excellent. Those are the two choices. Subliminally planting seeds, right? And finally, that 10,001 and 10,000, it's from a Chinese saying. I'm not afraid of 10,000 things coming at me, but I'm just afraid of that one in 10,000 chance of something bad happening. Again, that expresses a state of anxiety. It's a famous saying, right? It's because Chinese has a unit that's very weird. It's called 10,000. That's actually a unit as opposed to 1,000, which is like three zeros. We have something that says 10,000. So that's the Chinese saying. So all this you see, without showing a single Chinese character, but just showing some numbers, I'm expressing to you, what I want to really say with this slide is the richness that culture is encoded in the language. And you can see this, even without showing you a single Chinese character. These are Chinese concepts, just kind of already in Chinese numbers. And you can show up to, without learning Chinese, you can now show up to your other non-Chinese friends and impress them with your extensive Chinese knowledge. Isn't that great? And this is another thing that, when I first got into this Asian mental health thing, I found really fascinating. And some of you might have seen this before. It's from June 1972. But if you look at those three things, which is chicken, cow, and grass, which two belong together? Cow and the grass, right? How many would say cow in the grass, raise your hand? How many of you would say chicken and the cow go together, raise your hand? Right, so those are just kind of two culturally different ways of seeing how things belong. So people have done this, not once, but of course over many different kinds of stimuli. And it boils down to this. We can see the world through arbitrary rules. Knowledge, semantic knowledge, which is that we know that they are both animal kingdoms, or you can see things through relationships and stories, which is the cow eating the grass. And it turns out that if you do this test over and over again, the Asian way of seeing things tend to see the cow and the grass. So there's the Asian in you. Yes! When you woke up this morning, did you think that you were Asian? Look again in the mirror. There's the Asian in you. And for those of you who are Asian, you've been whitewashed. So, but this is just to say, in a split second, our ways of seeing the world, of how we categorize things, can be influenced. Again, it's not just from one test, but multiple tests. So don't worry, your Asian-ness is intact. But this is just to say that there are different ways of seeing the world, and we should not just assume there's only one way. And in fact, from a psychological point of view, the author had talked about Joseph Henrique, has written and coined this term, weird, if you've never heard of it, that the foundation of everything we know about Psych 101, and what makes healthy psychology, and what we teach in school, and the norms, it's all from weird people. Meaning Western, educated, industrialized, rich, and democratic societies. Specifically, Psych 101 students who need a credit, right? That's how we have all the norms of everything we know about healthy psychology. And he's written articles and books that it's actually the weirdest people in the earth. Because if you look at Asian culture, but if you look at African culture, if you look at all kinds of culture, all those norms are complete flipside, if you do any kind of this type of psychological testing. Because our Western education teaches us to prioritize and categorize certain things visibly or invisibly. I am Western educated. I'm proud of it. I'm proud to be part of a member APA. Don't take away my membership. Don't take away my award. APA is the greatest. Yay! And there are other ways of seeing the world that cultural psychiatry can enlivens us. So for example, Hofstede in one of the largest tech company in the world, not Apple or Microsoft, but IBM at the time, start doing cultural studies. And so this is the cultural profile of Canada and US. We are, you know, friendly neighbors. We're not a state yet in Canada, but we have very similar, you can see the highest peak is IDV. This is why we're weird in those cultural psychiatry testing. It's because of individualism. That's what binds us. This is, if you look at this profile and have a mental image, this is what Chinese looks like. You can see it's the opposite, flipside. In fact, they have to invent a new category just to capture LTO. It's called long-term orientation to see things in long distance. They have to invent a new category to capture the psyche of the Chinese. So it just again shows the cultural differences. And these days we do more than just cultural psychiatry testing. We also look at fMRIs and we can see Chinese people thinking about their mother. The parts of the brain that lights up is very different from average American, non-Chinese, who would think about their mother very similar. I believe that the profile is, if you think about your mother, it's similar to thinking a famous person, right? Whereas for the Chinese, it's like thinking about yourself. There's an extension of yourself and you can see that in the fMRI. And so even looking at meta-analysis, you can see that different parts of the brain light up because of culture. You can see it in a biological way, too. And you can see it, not only that, but also if you look at the pharmacogenetics, you can see there are differences. For example, if you look at the serotonin transporter gene, the L allele predicts good response to antidepressants, but that doesn't work in Asians. So this is just to the degree that even biologically, we can look at differences between cultures. And if we look at, of course, the explanatory model of illness, we can see that different groups—this is from our work with 1,000 women in Canada—we can see that different ethnic groups have very different ideas about how the world works. And just to kind of skip along here, I want to skip to some of the work that we've been doing using the ACT model. Thirteen minutes, that's a lifetime. Okay, great. So, oh, then I have a time to just kind of show off the slide. That in our group, we are promoting the idea, then, that a lot of the stuff residents don't know, like in training, don't know, of the importance of these cultural differences. How many of the stuff that I've talked about you already know? Maybe a lot of them you do, but maybe some of them you don't. So, in Canada, our group have been active in trying to push for guidelines in training in cultural psychiatry, but also, how do we train IMGs? Because IMGs, they come with different life experiences. They come with different challenges. How do we accommodate to them? And what's the flip side of that? Which is, what can we learn from IMGs? Because they are also bringing in their experiences, right? You know, Dr. Opaku, last night, at the Global Mental Health Dinner, was saying much the same, that a lot of IMGs that we're welcoming to Canada and U.S., they can be our future leaders. They can be enthusiastic about serving the world, and also, how to make America better with their own knowledge. How do we acknowledge that, as well? And finally, how do we take racism into our training? I want to shift gears a little bit, but not too much, and which is to show you this ACT model. Now, in my university, I teach CBT, Cognitive Behavioral Therapy. But one thing I noticed, over the years, is that CBT is very Western. Have you noticed? It's very Western, in terms of analyzing. Why? Because we do the Socratic dialogue. Why wouldn't it be Western, right? We're doing Socratic dialogue with people. So, I mean, it's great, and I love it, too. And some say that it's great for Chinese, too, because they like the practical nature. They like the fact that you are like a teacher to them. So, from an Asian point of view, some of them really love CBT. But there are things in life that CBT just doesn't work. Have you noticed that? I would like to say it works for everything. I tell my residents that. I teach it. Many of my residents in the room. CBT is great. I teach it. Supervision every Monday morning. CBT is great. And I also found a limitation of CBT, so I was searching for alternative. And acceptance and commitment therapy is what I arrived at, because I feel that has a lot of Asian-ness in it. Acceptance commitment therapy, basically, right now, is an evidence-based model. It's kind of like CBT, in working with thoughts, but it's acceptance-based, and it's mindfulness-based. So, it's great. I really love it. And I invented these hand signs to teach it. I'll teach it to you now in 15 seconds. So, if you push your hands together, if you push it really hard, and you feel the pressure, that's like when you feel pressure in life. So, we can diffuse from it by separating our hands, meaning that we can give some space to notice our thoughts and feelings, or just our thoughts and feelings by giving up space. We can open up to acceptance. So, instead of doing what's rational, what's irrational, like CBT, just open up to accept that we have these thoughts and feelings in acceptance. We come to the present moment, not to the past or the future. Find a center that is centering yourself to the now. If you do a fist in the cup, you ask yourself, are you the cup, or are you the content? In other words, are you the coffee cup? Which means that you can chuck away yesterday's coffee, which is old, yesterday's trauma, but you're ready for a fresh cup of coffee. Or as I tell my Chinese patients, are you the rice bowl or the rice? You chuck away yesterday's fried rice, and today you have a new fresh bowl of rice. Isn't that great? And then if you cup yourself, you ask yourself, what values matter most to you in life? What you don't want to let slip through your fingers if you're in the desert? And then if you do pinky swear, which is, how can you commit to your values through actions? So, this is my way of explaining the ACT model. And I find that culturally does a lot better than trying to define each term. But anyways, I would just like to say that I love the ACT model, and we've been using it. And we've also brought it back to Asia in different ways, in Hong Kong, in South Korea. This is actually two nights ago, a screenshot that I taught it to Koreans. And this upper right hand corner, she's responsible for the health and welfare of people working in Samsung. So, she learned it, like some ACT from me, and she's presenting her research on how it's been helping other psychotherapists in Korea from burnout. And she was presenting her data. So, this is just some of the work of how it can be very helpful. I'm kind of promoting ACT here, you can tell. And it also means something personal in my life. This is my son. What's so special about him is that he brings balance in my life, as you can see on the right hand side. I need to juggle him. Because he's a bundle of energy, he has ADHD. He's also autistic in the autistic spectrum. He always has a nice smile, even when you're yelling at him. He's quite a lexiconic. And he's proud of it. And anyways, so, we have been using ACT for caregivers. In other words, for parents who have children with autism, because we find that this is another group that CBT doesn't work. In fact, they've been often told that if they are better parents, their children will be less autistic, because they're supposed to have master behavioral interventions. Are you aware of that? I only learned that when I became a parent, that apparently, parents are supposed to be excellent behavioral analysts if your child is autistic, and because there's a window. And before that window closes, you better intervene on your child, like a psychologist would, because otherwise, you're dooming your child to lifelong autism, which is severe. Right, so, the tremendous pressure. We've been using ACT on it, and we've shown that it's very helpful. And it's been increasing their ability to take care of themselves, even as it does not destroy their parenting. But all this is to say that it's helpful for this population, and we are now also looking at cultural differences. So, today, not today, but next week, we'll have a black caregiver group focusing on the black population. Apparently, my model has been spread to India, so I've been hearing reports from India using it in India, and we are also spreading to Korea. There's a Korean woman who's endeavored to do it in Korea. So, this is to say that the ACT model, the acceptance model, can be helpful to address diversity issues. This is something that we've done in the CHAMP study for HIV in Toronto. And we've shown that it helps the HIV community when we use this ACT model to help minoritized populations, including Asians, Hispanics, and black people with HIV. Because they have this intersectionality of racism, plus being discriminated based on HIV status. But ACT, based on this acceptance model, helps create this acceptance space, including working with internalized stigma. And they can help, because of this kind of commitment to action piece, it helps people who are in a minoritized position becoming their own champions against HIV stigma. We then brought this to the Asian community about stigma, because if you didn't know, mental illness stigma, it's a problem in Asians, too, as well as other communities. So, we did this as an Asian men's study, funded by Movember. So, we target, you know, earlier we did a study on Southeast Asian women, so this time we were funded by Movember to study Asian men, because of Asian culture, men are even less expressive of their needs. But, you know, we did the miracle, we actually attract like 500 Asian men in Toronto alone, it's a multi-center study, to use ACT model to decrease their stigma, and it's, like, an amazing thing. And now we are having an implementation science using the ACT model, but to spread it to China. And we are collaborating with six universities in Jinan to take our intervention there, to help decrease mental illness stigma in China, working there. I told you during the pandemic, we also were hard at work here. We developed a model of using ACT, but also, you can see, surrounded by social justice principles, and we were able to develop an online intervention using the ACT model for social justice work. And, I'll just show you the results, which, we had two groups, one is healthcare providers of all ethnicity, the other, the non-HCP, is basically the Chinese group, because we had two sources of funding. As you heard, the Chinese committee was being discriminated against. So, we were able to target the Chinese population and bring back this intervention, as well as healthcare providers. What we show is that this model increases psychological flexibility, decrease distress, and increase resilience. So, all of this is to say that there is a lot that can be helpful with the ACT model. And, I think that the way we've done ACT, one of the important things is that we talk about the importance of cultural values. The problem of doing ACT the traditional, Western way, is that we focus on individual values. So, how our group has done it with different cultural groups, and how we're able to make it work with different cultural groups, is to ask people to identify, first, the cultural values. And, I think that is one of the differences. But, here, I want to come, finally, in my last few slides, to come back to why I think that there's a lot to be said about ACT, is that there's a lot of ACT that's found in, actually, Buddhism. And, I think that this is where it comes to the part where I think I start off by saying that CBD is so amazing, you know, because it comes from Socrates. There's a lot of Western wisdom there. But, ACT and mindfulness interventions, I think they're so great, even though it's also originated from the States, U.S. There's actually a lot of ancient Asian wisdom in it. So, if we look at Buddhism, a lot of the core noble truth can be found. And, in fact, I have done various groups with holy Cambodian monks among the Cambodian. We have taught a course on Buddhism and ACT, and I've written some papers and chapters. The thing is that this is actually an amazing topic to discuss, because I started a Buddhism and Psychiatry Fellowship at U of T, the only thing of its kind, which is to look at how Buddhist philosophy might be helpful in psychiatry. But, this is a lively issue in the ACT community, because someone would say that we need to acknowledge Asian philosophies from Buddhism and its practices in mindfulness, in MBCT, in DBT, in ACT. And, you know what the answer is? No, we invented it here in the West. It's a real debate. We can get into that debate. There are Buddhist and white gurus teaching how to do mindfulness, charging you thousands of dollars. I have Asian psychologists saying, I've been raised in Asia, we've talked about Buddhism for thousands of years, but it's not until this guy said it, it now all made sense to me. We need to learn from this white guy. So, there are Asians that completely agree with it, and then there are other Asians that are enraged, that says, these people are selling tons of books, having randomized controlled trial, but a lot of it comes from Buddhism. And, not only that, because of the shallow understanding of it, you see mindfulness being trained to kill better around soldiers. Where is the compassion of Buddhism in that? So, there are many layers of discussion we can talk about. Do we need to acknowledge? Is this cultural appropriation or even cultural misappropriation in psychiatry? I think we need to ponder. I want to show you just kind of one more slide before I will give you the conclusion slides. And, this is what happens when we study a culture when we don't really understand it. Because our group has been also writing paper about the Chinese culture and things like this. But, someone unearthed this paper and started quoting from it. And, it's really funny because this is like what happens in Hong Kong. Apparently, and I didn't know this in Hong Kong, there are different categories of people. And, depending on who you give a gift to, there are different Chinese terminology that I didn't know about. I was just talking to Michael the other day and we said we have Yi Hei. Apparently, that puts us in the close friends category. Because a closer friend would not have Yi Hei and a farther friend does not have Yi Hei in this table. But, this is from a prominent anthropologist who went to Hong Kong and studied Chinese culture. I have to say, I look at this table and I just laugh. I just laugh because it does not make any sense to me. But, this is just to say that there is a lot of Chinese wisdom. And, we do need a lot of study. We need a lot of care. But, we also need to study it carefully or a lot would be lost in translation. Or, worse yet, a lot would be lost in mistranslation. And, I hope that this brings us final closure to the final slide about butterfly. That I hope to give you a metaphor that we can all transform like a butterfly. But, more importantly, I just want to end here with a kaleidoscope of butterfly. That is to say that we start today's talk about what is being an Asian about. I hope you can see that there is a kaleidoscope of different ideas of not just one single one. But, it's more beautiful because of the butterfly effect. That each of us is part of the piece of the puzzle that's colorful and powerful like the butterfly effect. And, at the end, it's also the collective that's more than the sum of its parts. So, with that, I leave you the butterfly, kaleidoscope, and miscellaneous thoughts. So, thank you for listening to my reflections. Thank you.

Asian cultural identity

psychiatry

Kung Po Hsu Award

cultural competence

mental health

immigrants

model minority myth

culturally sensitive programs

acceptance and commitment therapy

Buddhism

cultural diversity

cultural appropriation

kaleidoscope metaphor