Interview with Dr. Richard Feng | Mental Health of Asian Americans during the recent rise in Anti-Asian violence

Interviewee: Richard Feng, MD    

Interviewer: Billy Zeng, Elaine Cheung, Caven Chow                        

Transcriber: Billy Zeng

Location: Zoom         

Date:  February 29th, 2021          

Keywords: Chinese and Asian mental health, Anti-Asian violence, COVID, psychiatry

Interview Highlights

On himself

Dr. Feng is a community psychiatrist in San Francisco. He’s a 2nd generation Chinese immigrant, his parents grew up in a rural background in Zhongshan, China. They immigrated to America where they worked blue collared jobs, dad in construction and mom in hotel housekeeping. He serves the patients who come from the Asian working class background in San Francisco. Of note, he is one of the few Cantonese-speaking Psychiatrists in San Francisco. 

On his typical patients

He sees patients who are managing chronic mental illnesses such as schizophrenia and bipolar disorder. Over time he has developed strong relationships with his patients such that they do fairly well with support from their family, social safety nets, and medication, a typical day at the clinic would be uneventful. For his patients during the pandemic, he stressed an important factor of maintaining good mental health is to have strong family support with multiple caregivers. 

Pandemic Insights

Patients are seeing a lot more intra-family tensions due to being at home with their family for a long time. These intra-family tensions may be exacerbated by previous traumas, especially intergenerational trauma that are now being concentrated in the household. There is a mental wellness cost to adhering to shelter-in-place that is often neglected. People need to practice self-compassion and forgive themselves for not doing the best during these times. 

On homelessness

San Francisco Department of Public Health clinics have been opened for in person visits for homeless populations. While there may be personal and demographic risk to homelessness, Dr. Feng believes more needs to be done at multiple levels. Notably, he sees homeless patients from all walks of life, from newer immigrants to families with multiple generations in America, and different races. People often point to cities to solve homelessness problems, but homelessness is a symptom of larger social inequities which cities cannot solve in isolation. The fact that homelessness can be pervasive across demographic factors point to the role that the state and federal government must play in order to prevent and support homeless populations. 

On Anti-Asian violence

Many of his patients are very concerned about the anti-Asian violence more than the virus. For COVID, his patients feel they can at least protect themselves with public health precautions, the anti-Asian violence has an inherent human element and there’s less control. People have been vocal that although the pandemic affects us all, only the anti-Asian violence has made the Asian American community question whether we belong in America. People were comfortable going out with safety precautions with COVID, but are very afraid to go out amidst the violence.

On Racial tensions

The interviewers noted the mixed views on addressing racial tensions in the Asian community. There are some who believe in cross-cultural allyship, re-investment in impoverished communities, and restorative justice, whereas others want increased policing. The violence has stoked fears and anger as some have started raising racist and sometimes violent undertones against Black people. 

Dr. Feng also bemoans the rise of right-wing type ideology held by some in the community. He is tempted to teach patients, who hold stereotype views, about the history of racism. Historically, the Black Community had made great strides for all communities of color. However, there are limitations to how much he can do as a physician. Outside of the clinic, there needs to be more positive daily one-on-one social interactions between racial groups, and beyond that there needs to be systematic effort in addressing the disparate issues faced by communities of color. 

Final Thoughts

We talked about what the media typically neglects when highlighting how well Asians handle the pandemic. It is hard to talk about Asians without first disaggregating by specific race because of the vast difference in backgrounds. https://www.mckinsey.com/industries/public-and-social-sector/our-insights/covid-19-and-advancing-asian-american-recovery 

And even for Asians that did do better, there’s a cost to sheltering in place. There is immense mental health and stress faced by families right now and that will impact their future.

Full Transcript edited for Readability

Feb 24th 2021, This interview was conducted with Dr. Richard Feng, a Community Psychiatrist serving moderate to severe psychiatric patients in San Francisco his work focus on Asian and Homeless population in San Francisco. 

Zeng: What is a one liner you would use to describe yourself?

Feng: I am a community psychiatrist in San Francisco, 2nd generation chinese immigrant. My parents came over here and I was born in America. I grew up in San Francisco and I’ve been interested in serving the community from which I grew up in which is the Asian working class community in San Francisco.

How were the holidays different for you this year?

I think in general they’ve been smaller and simpler but they’ve also felt more meaningful. For instance Christmas, a lot of the extra fluff that came with the holidays were discarded. And in it’s place I feel like we really focused on the core parts of the holidays which meant spending time with family. In some ways it’s not as fun because that sort of bustling Chinese giant gatherings didn’t happen but in other ways it felt special because a lot of the extra stuff felt stripped away and we really got to focus on the people we love. 

In the lunar new year, we didn’t have to worry about going to the bank and getting crisp banknotes for the red envelopes. Because sometimes the worry was the stress of getting the best red envelope, the best decorations. Instead we focus on the joy of being with family. 

I celebrated with just my immediate family and virtually with others. We decided early on to create a bubble, so it was a bubble holiday. 

We ordered a poon choy 盤菜 which is something we never really done before. But I noticed Poon choy had taken added significance this year and were extremely popular. To be honest I didn’t really like it. It wasn’t something we usually do. The food were mediocre. But I think the point of the dish having the opportunity to gather the family and share one giant dish takes added significance this year. Much like Turkeys, no one really enjoy it it’s dry not moist, but sharing it is the symbolism. 

Simon Law flickr CC BY-SA

Talking about Poon Choy, are you from a Hakka Background? (We recently learned that Poon Choy is a Hakka Background dish with multiple origin stories. Guangdong is a huge region and there’s many different cultural variation in Cantonese backgrounds)

My family was from the Guangzhou region. There’s a lot of mixture of food and customs that happens in Guangdong. 

Wikimedia Commons

One of the common stereotypes is that our parents want us to go into medicine, but my mom actually didn’t. She thought it was a financially risky move and also thought the stressful environment might be triggering for me. Given that she’s a village lady from Toishan I think that was actually pretty advanced. How did your family think about your decision to enter medicine?  

My parents actually grew up in Zhongshan, a solid peasant background. While my mom was supportive of me going into Medicine, I think the mom part of her was worried about the stress of me working as a physician. I think people generally know that physicians tend to have terrible work-life balances and are known to be workaholics and often work at the expense of their personal family lives and my mom was acutely worried about that happening. 

She actually was supportive of me going into psychiatry as it is one of the more humane specialties. You rarely work weekends, holidays. Weekends, holidays, and family gatherings were just the cornerstone of my culture and the idea of missing out was really a bothersome one for her. Once she realized psychiatry was one of the fields that have a life outside of medicine. It is true that psychiatry is a field that value wellness and for our workforce as well. We can’t be advocates to advocate wellness if we don’t do it ourselves. Tough to advocate for wellness and not practice it ourselves. 

Given the stigma around mental health in Chinese community, how was the general family perspective of you going into Psychiatry?

Asian Americans come into medicine for different reasons. And probably because of this stigma fewer Asians have come into psychiatry. And it’s interesting a common question I get in residency question was how does my family think about me going into psychiatry that I think does speak to that there is the stigma of mental health in some Asian cultures. 

Fortunately, I didn’t really experience that. My sense was that I was able to experience the best of both worlds, I still had the intellectual accomplishment of becoming a physician and obviously the compensation that mattered to working class families. And especially being in a specialty that had a humane work-life balance and having the opportunity to work with my community. In fact I even got some supportive comments of psychiatry considered being cleaner specialities because I don’t have to touch guts or blood. 

How has COVID affected you personally?

My family is lucky in terms of timing. My father was a contractor in construction and my mom was a hotel housekeeper. They would have both been in the front lines. As luck would have it they are both retired. So we were in the position to hunker down. 

I found myself in the dual position of being a son and having to enforce the covid safety precautions. And this is similar to my patients experience, their adult children are often the ones who have to nag their parents to adhere to COVID precautions, reprimanding them for leaving the house, and not wearing their mask. I was very lucky in that they did not have to work and contact people with COVID. If it would have happened 5 years earlier it would have been a different story and they would have been extremely at high risk. 

Who is your typical patient cohort? How has COVID-19 affected you and your practice?

I work with the Medi-Cal and uninsured population in San Francisco dealing with severe mental illness. I’m also one of the very few Cantonese speaking providers in the area so I have a lot of patients who are working class monolingual Chinese speaking, where the majority have not completed High school and have a limited educational background and at the same dealing with severe mental illness. So I have a lot of patient who are dealing with schizophrenia, bipolar disorder, severe PTSD for a variety of reasons, in addition to folks who are dealing with depression, anxiety as well.
 

Sometimes because we don’t see severe mental illnesses, I think in the Chinese community, we just assume they don’t exist, until we see someone who’s in front of us suffering from it. Is there something you think the Chinese community should know about more severe mental illnesses? Or how would you coach your patient’s family to think about this especially given the educational disparities?

These are chronic medical conditions, and much like chronic diabetes, heart conditions, and chronic pain. It’s important to keep in mind that these are manageable, medications are very far along now they are quite effective. So a lot of patients live normal and happy lives with their conditions and in this case it’s mental diseases. Oftentimes, people think that people with mental illness are unstable and while I can see that, the vast majority of my caseload so far are stable. So if you were to shadow my practice one day, you’ll see it’s very boring, if you ask me what we talk about, we talk about what everyone talks about. 

At this point I have a great relationship with my patients, they trust me, their family trusts me, they take medication, there’s an openness in communication. And so in an extent you see my patient walking down the street, you won’t see them as different as anyone else and that speaks to the role of medications, safety net, and family in maintaining the patient's quality of life. So I think that’s hearty for folks to hear about. 

What do you see in your patient’s background that helps them? Is there something inherent to their cultural or family structure? 

From my experience, the family that does well are the ones that have multi-layered support system. So it’s not just one person taking care of one patient. So in practice you’ll see the patient come in with a rotating cast of family members, you’ll see their brothers, sisters, in-laws. The one where you sense have a network of support a community, those tend to do the best. For one-caretaker cases, there would be caregiver burnout, and that affects the patient as well. 

Jarmoluk. Pixabay.

Were there any problems exacerbated by COVID that you’ve come across?

While I treat and manage severe mental illnesses like schizophrenia, folks with delusions and hallucinations, in reality in the day-day the most distressing thing in my patients are your run of the mill intra-family dynamics which are often-times exacerbated by mental illness. If you think about a family who has trauma, and I’m talking about trauma with a capital T this is inclusive of intergenerational trauma, by the time they show up in my office they’re dealing with trauma literally decades before. You see this in how families interact with each other. One example may be a grandma who is very difficult, the family thinks is 麻煩, which is a common scenario. While the family describes the grandma as difficult, if you dig a little bit you’ll find that there are components of trauma and loss and that permeates through all the interaction with their family.

KOBPS2 VIA GETTY IMAGES

So with COVID what happens is that a lot of Asian families are hunkering down together, not going to work, students not going to school, so they’re spending a lot of time together and that is exacerbating a lot of family relationships. At the same time this suffocating aspect being around together all the time is really wearing down on the entire family. So I’m talking about grandma, grandpa, the children, the village, everyone is dealing with that now. 

And this is San Francisco so we don’t have huge houses. This is far extreme of what was done in China where people lock down for a few weeks at a time. We’re almost approaching one year of lock down. While Asians as a whole has fewer cases than other groups (because of hunkering down), but you have to think about the mental health cost of that happening which I believe will be apparent.  

How do you coach your families who are hunkering all together?

The main message is to acknowledge how hard this is, this is unprecedented, scientific experiments. Humans weren’t meant to be stuck with each other for this long. In China they only did this for about two months and it was lifted. In some cases, Asian families (here) are doing it voluntarily which is reasonable but it’s a constant level of stress. Approaching a year of this, the social stressors that predated COVID, the financial, legal, and social pre-existing trauma is just being piled on top of by COVID. 

So my general message is cut yourself some slack, give yourself some compassion. So if you feel like you’re not the perfect daughter, son, or parent as you would like to be, cut yourself some slack. Everyone is trying the best they can right now. 

We also wanted to ask more about your work on the Homeless Asian population.

Asians comprise the smaller percent of the homeless population and usually they are the most severely severed. Clinics at the city and county have been opened in person (during the pandemic) with safety precautions, because there’s a need for our most vulnerable members which include the unsheltered. In for them and my most severe patients, to put it bluntly, they’ve been dealing with so much that the COVID pandemic by itself didn’t affect them as much. It limited access for them. 

Is there anything unique of Asian communities and homelessness? 

Well there’s a story to every unsheltered person. Oftentimes, but not always, there’s a component of mental illness and for communities of color groups don’t have much of a safety net to begin with; sometimes it doesn’t take much to become unsheltered. Generally while Asians who are unsheltered might be more impaired, that doesn’t take away the fact of the failure of our system on multiple levels. 

In your perspective is homelessness something we can eventually solve?

Homelessness is a symptom of a larger systemic issue. While in San Francisco we try to focus on homelessness as an issue, unless there are some major changes in the way our society functions, this symptom will remain. Even if we were to say San Francisco city itself solves homelessness, it’s surrounded by so many cities and other states, there’s no way we can solve it on a local level. It’s weird how it had fallen on local authorities to address this; this issue requires a coordinated federal and state response. At the local level we can put band-aids on everything, add more housing, but it doesn’t address the underlying problems that led to homelessness, in our economic and political system. 

Are there certain Asian groups that stand out for risk of homelessness?

Not really. I’ve seen the entire spectrum. You see 1st, 2nd, 3rd generation Asians ending up homeless. I think it parallels what we know of homeless populations in other groups. The thing about homelessness is that it cuts across a lot of demographics. 

Maybe some data might reveal that Southeast Asians might be at higher risk for it, you’ll have to dig into the data. However, I’m more struck by the fact where people who end up homeless are  quote unquote regular people; and that is what I think should be the wake up call for people, it can be anybody it’s not impossible to happen to someone close to us.  

What are your thoughts about the recent Anti-Asian violence and had that come up in your clinic regarding that?

It actually seems like my patients are more stressed by anti-Asian violence than by COVID itself. Whereas COVID is a disease, a virus, there’s no human aspect to it. I feel the anti-Asian violence really hit my patient hard. For example, while folks would still go out and buy groceries amidst the pandemic, with the surge of anti-Asian violence those same folks and family are really scared to go out and get groceries. And I think that goes to the anxiety Asians feel about their position here in America. I work with the working class community and they feel very unstable about their position here on multiple levels, with this anti-Asian violence this really compounded upon that. And it’s become a rude awakening on how others perceive them in America. 

Here in San Francisco it’s got a very large Asian population, some of my patient had felt complacent and comfortable at times because of the support of community. What the anti-Asian violence done is that it shattered that and makes people feel very uncomfortable, even more so than COVID. With COVID they know what to do to minimize their risk, the violence is something that is very real and it’s in some ways a bigger blow to my patients. 

What do you think will happen to the anti-Asian sentiment itself, it has happened in the past such as with Japanese internment. Like will it resolve by itself or do you think there’ll be a process?

API community looking carefully at how leaders respond to it, see who is supportive of them. It’s going to take time to heal. The trust has been broken. To repair broken trust there needs to be statements with concrete actions to demonstrate that these folks can trust again. And that’s the same with patients. If you break the trust, you can repair it, but it’ll take time and hard work. 

To acknowledge, many in the Asian community point to the perpetrators of the crime being young Black men, which furthers the Black criminality bias, and they would like to see more policing. Yet Russel Jeung (co-founder of Stop AAPI Hate) and others who work with poor Asian communities don’t see that more policing should be the solution because this perpetuates injustices that’s affecting the Black community. This seems like a thin margin to navigate, how can leaders gain the trust without causing more injustices to other communities? In your mind are there ways to navigate this in the community? Or even within our personal relationships? 

It’s real, you see the rise of right-wing feelings in Chinese working class Americans in particular. Trump increased his vote margin of Chinese Americans in San Francisco and I wonder if it’s due to that. 

In terms of a physician talking with patients about these racial tensions, there’s the tendency to want to lecture patients, tell them about the history of racism, and the fact that the Black community has been the most helpful and kind to the API community. You want to tell them about the rights and privileges we have are due in large part to the hard work and sacrifice in the Black community. You want to tell them and have them understand that, but I come to see that patients just feel like they are being lectured at and it doesn't change how they feel at the ground level.  

(Outside of the clinic) One and one interactions can help such as a Chinese shopkeeper in Chinatown Oakland sharing food with one of the Black security members. But there are reasons why communities are feeling stressed and overwhelmed and that puts us in the same boat. However, like homelessness issue, there needs to be policies at the federal and state level that will improve communities of color in the general sense. It’s not easy, but it needs to be done. 

How’s the trust of vaccines in Asian community? 

I see some data that says Asians are the most trusting and that’s like “70-80%”. Yet, the Asian community has also caught onto misinformation. However, mainstream media hasn’t caught up to that. When they’re thinking of Asian community they’re thinking of your college graduate, professional, professor and PhD types who are onboard with taking the vaccine. But keep in mind it’s not a monolithic group.

There are tons of patients who are skeptical and wondering about it. As a physician, I’m in a very unique and privileged position to give them my opinion and listen carefully to their thoughts. This goes back to the trust I earned over years of working with my patients, this is when I’m cashing in the chips and say “this is why I want you to take the vaccine”, they’re not going to listen to something from a commercial, it needs to come from someone they trust. 

Any final thoughts? 

Just keep in mind how unusual this is. I also see articles about how “successful” the API community has done in response to COVID, but that isn't necessarily inclusive of a huge part of our community. And even if we were to accept the fact that we’ve done better, there’s a cost to it, and I think that cost is the mental health and stress that families are under right now and we’ll see the ripples of that moving forward.