Education Lessons Medicine Observations Reflection

On Being a Person.

Upon looking at me, there’s no doubt about it: I am Asian.

My ethnicity occasionally becomes a topic of conversation with patients. Some immediately ask me, “Yang… that’s Chinese, right?”

Others take a different approach:

“Where are you from?”

“Where am I from?” (This is meant to clarify the question, as it can mean different things….)

“I mean, where did your family come from? What part of Asia?”

Patients with significant psychotic symptoms occasionally start conversations with me like this:

“Konnichiwa! Ichiban? Teriyaki?”

or they might say things like this:

“God has a good recipe for kim chi. Do you want to know what it is?”

For the most part, it is completely clear that these conversations arise from benign intentions: Patients are trying to make a connection.

Even if I speak English with a perfect California accent or wear clothes that blend in with the fashion of Seattle, I cannot mask that I am Asian. It is a significant part of my identity and I bring it with me wherever I go.

While in training psychiatrists are often encouraged to present oneself as a “blank slate”. This psychodynaimc argument states that the more neutral you are—in speech, attire, manner etc.—the more you can analyze the “transference”, or what reactions (emotions, thoughts, behaviors) patients have upon interacting with you. These reactions are the grist for the therapeutic mill.

We, however, can never present ourselves as blank slates. Patients—people!—notice both what we bring to an interaction and what is absent. People might have opinions about my ethnicity, my facial expressions, the tone of my voice, or the scribbles I make during the conversation. They might also have opinions if I make few utterances, maintain an expressionless face, and answer questions only with questions (as demonstrated above).

Instead of being a “blank slate”, sometimes the best thing we can do as psychiatrists is to be a person.[1. To be clear, a psychiatrist should be a professional person; this is no time for sloppiness or disregard for a patient’s wellbeing and dignity. Being the best professional person you can be is still being a person.]

If people have relationship difficulties, we can be an actual person so that the patient can learn how relationships with people can be different. If people come to treatment because they have challenging relationships with themselves, we can be an actual person so the patient can learn how these views of self affect not only them, but also other people. If people have tenuous connections with reality, we can be an actual person who provides accurate feedback about “reality” (and make very clear that we’re not trying to steal their internal organs, etc.).

Being an actual person can be scary. We might worry what people (colleagues, patients, others) think of us. However, that vulnerability and authenticity we bring as people to the clinical interaction might be the most healing and inspiring to our patients.