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

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.

  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.