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Chapter 1
Growing Up Multicultural: China and the Philippines
I was born Chiu Tong Ping on February 18, 1935, at Gulangyu, China to Anna Lee
and Chiu Kui Lim. When I was about two or three years old, my parents took me
from China to Manila, Philippines, along with five other boys, one of whom was
my brother. My father pretended the other four were his sons, so he could get
them out of the harsh political climate in China. Ultimately, my parents were
to give birth to 10 children, five boys and five girls, most of them born in
Manila.
My family left China for Manila for a variety of reasons. One, I
believe, was political. The Chinese Nationalists and Communists were at war,
and my mother had leftist leanings and ideologies. She was, in fact, famous for
her political convictions, and many people called her the "Pink Communist"
throughout the 1920s and early 1930s.
Although my mother was an elementary
school teacher in China, she-along with her best friend Victoria-mixed the
theology of children's education and Lenin's teachings. The civil war separated
the best friends, however. Soon my mother received a bittersweet letter from
Victoria that said, in part: "My dear Ana: The war has finally decided our
fates, has it not? You in the Philippines. I here in Formosa. Both islands of
some strange destiny. We are both in exile. The future looks bleak to me. . . .
When will I be able to see you again? I am afraid to ask!" She signed the
letter, "Forever, Victoria." Ana would never visit Formosa, however, and
Victoria would never attempt to leave. The best friends were never to see each
other again.
In addition to the political turmoil in China, we also left for
the Philippines, I believe, for economic reasons. My father, a physician in
Western medicine, wanted to practice his calling, but he believed he could not
work and provide for us in China.
Our safety also was a concern and motivated
us to go to Manila. My parents were looking for a home in which all of us could
feel secure, both politically and psychologically. I believe they were seeking
solace, preferably in a multicultural setting, and a feeling of belonging.
During WWII, my father sent me to an all-Japanese elementary school in Manila.
I was the only Chinese student there, but I did speak Japanese, as well as
Spanish. This school was the only one open during the War, as Japan occupied
the Philippines. One day, a classmate, about five years old, said to me,
"You're not Japanese." Although the statement was literally true, his bold
comment made me feel unaccepted. After the War, my parents sent me to an
all-Filipino, English- speaking school; and again, I was the only Chinese
person there
I believe these childhood experiences left me with a "minority
syndrome." For one thing, I desperately wanted to be accepted. I also felt
persecuted often, because of my family's ties with the Japanese before and
during WWII. My father was treating Japanese soldiers' ailments, and so my
family was accused of "collaborating" with the Japanese. Further, I had
imagined fears that the Chinese and Filipinos would harm me and my family,
including depriving us of an economic livelihood.
These early childhood
experiences may have given me an interest in other cultures-if only for the
sake of survival; but I suspect that my proximity to and interaction with the
Filipino and Japanese people, as well as individuals from other cultures,
whetted my curiosity about "others." After all, my family and I-whether we
liked it or not-often were thrown into the multicultural arena; and so we
developed a need to know, understand and live with people from foreign
countries.
As a result of this forced interaction, I believe I developed the
goals of understanding the thinking of people from other cultures, and of
having the ability to think as someone from another culture. This ability is
the ultimate, it seems to me, in intercultural recognition and, perhaps, in
intracultural recognition.
Education and Medical School
During my teenage years, I found myself on the
"education treadmill" so typical in America today. At 13, I began attending the
Arellano High School, in Manila, and graduated in 1952. Then I immediately went
on to the University of the Philippines, in Quezon City, where my fields of
study were Liberal Arts and Sciences (1952-54) and Music study: the piano
(1952-53). In 1954, I began Far Eastern University, in Manila, where I received
the Associate in Arts degree on April 12, 1955.
I was then about 20 years of
age, and I found myself thinking of attending medical school. Why? I'm not
certain. Perhaps it was because my father was a physician. Or was it that if I
were a doctor, I could likely get into the United States? I was very aware of
America and attracted to that bastion of modernity, so far away from Asian
culture, in every way. Whatever my motivation, in 1955 I applied and was
accepted to the Institute of Medicine, Far Eastern University, in Manila.
Four
years later, in 1959, with only a year left to graduation, I had not yet
decided on a medical specialty. Was this indecision because, in my heart of
hearts, I still wanted to be a concert pianist-my early aspiration? After
all, I still was studying the piano while in medical school, and every morning
I played piano for the staff of the hospital! If that was my secret desire-to
be a concert soloist-it remained a secret, even to me.
My father wanted me to
be an internist, but before long, I found myself thinking of a specialty in
Psychiatry-an idea encouraged by the director of a tiny hospital on an island
about two hours by plane from Manila. The director was an M.D. and a
missionary; and his wife, by an amazing coincidence, was born on the Chinese
island where I was born, Gulangyu. The more I thought about it, the more I
liked the idea of a Psychiatric specialty. Part of the reason for the
attraction to Psychiatry, I believe, is that I thought of it as a "little
different."
The following year, 1960, I graduated from Far Eastern University
with the degree of Doctor of Medicine. Immediately I began a one-year
postgraduate externship at Chinese General Hospital, in Manila.
Around that
time, my family and I decided to go to America, albeit separately. I was to
arrive first, and started preparing for examinations in both Medicine and
English, so that I could get into the States and also work in a hospital as an
intern. I applied to several places and was accepted by Kings County Hospital
Center, in Brooklyn, New York.
Internship and Residency (1961-65)
Internship
When I first arrived at Kings
County Hospital to begin my one-year internship, I was assigned a room in the
Hospital, where I was to live. Although I had not yet made any friendships, I
did have a brother who was living in New Jersey. As it turned out, because of
my nightmarish experience at the Hospital, I only saw him about once a month.
Most of my friends were coworkers, and my socializing was done on the job.
What
made the internship a nightmare? Mainly, it was the grueling schedule I had to
keep, the heavy volume of patients I had to see, and the many emergencies I had
to deal with. In addition, some of the interns also caused me and others
troubles. One intern, for example, was so involved hypnotizing patients in the
Surgical Ward, that me and another intern, an Afro-American Black woman, had to
cover for him, do his work, and this extra burden greatly upset us, of course.
What made the situation even more difficult was that all this tortuous work
activity took place in a highly negative healthcare environment. A sense of
this environment can be gleaned from a recent New York Times article (July 17,
1997), which described Kings County Hospital as "the city's largest and most
dilapidated public medical center." The Hospital now has about 800 beds, and
there are plans to modernize the buildings and reduce the number of beds to
550, in an attempt to make the hospital economically viable in the age of
Managed Care. When I was there, however, from July 1961 to June 1962, Kings
County had about 2000 beds!
The Times article went on to state that "More than
30 percent of the households in the area served by Kings County-East
Flatbush, Flatbush, Bedford-Stuyvesant, East New York and Brownsville-live
below poverty level. A fifth are enrolled in Medicaid." These largely poor and
Black patients are treated-as they were when I was there-"in large open
wards reminiscent of WWI military hospitals." And the patients and doctors
still complain-as they did when I was there-"of unsanitary, frightening and
often dangerous conditions in its 60 year-old buildings."
During my rotating
internship, in addition to my hospital duties, I was preparing for a residency
in Psychiatry, and had applied to various places. My decision to specialize in
Psychiatry obviously had stuck with me; and my resolve was strengthened at
Kings County, I believe, by one of the interns, who is now the Director of
Psychiatry at Misericordia Hospital. At that time, I did not know exactly what
type of Psychiatrist I would become, what "school" of Psychiatry, if any, I
would practice. I do recall that I was not reading any psychiatric literature
per se, though I was attracted to the literature of psychiatrically oriented
authors, especially William James and Fyodor Dostoyevsky.
Residency
In 1962 I began my Psychiatric residency at the Illinois State
Psychiatric Institute in Chicago. After Kings County, this experience was like
dipping myself in warm water, as I felt the congeniality and camaraderie of my
coresidents. I quickly saw, on the other hand, that the residency would
present me with a fierce professional challenge. I fused with the situation,
however, became absorbed into the arena, and was "combat ready," usually with a
smile.
As I acclimated professionally, I settled into my residential abode in
the Institute, which was to be my home for the next two years. (During my third
year, I finally rented an apartment on the "outside.") My room was on the
third floor, where all the residences were, in the 11-floor building. Beneath
me, on the ground floor, were the clinics for outpatients and the business
offices; on the second floor were classrooms. Above me, on floors 4 through
11, were inpatients.
It took me a while to accommodate myself to the different
inpatient floors, since each one was run by a different university with a
different orientation or emphasis, such as shock therapy, Jungian therapy, or
Reeseian therapy (after Michael Reese). The patients, overall, were mainly
Caucasian and Black Americans, and thus not especially "multicultural."
As I
progressed through my residency, I found myself developing an eclectic approach
to Psychiatry. Perhaps this was because of the various psychiatric orientations
practiced at the Institute. In any case, I never embraced a specific philosophy
or theoretical bent, and had no clinical preference for either medication or
dynamic psychotherapy.
I did think before long, however, that Freudian analysis
was not going to be my orientation, since I was interested in how to solve
patients' problems as soon as possible. And I found myself developing a desire
to do community mental health work, perhaps because I had been living in
medical institutions for so long, or because of my experiences in Manila.
Whatever the reasons, some of the contours of my future professional life were
beginning to unfold: short-term clinical treatment in a community context.
While the patients at the Institute were mainly native-born Americans, my
colleagues in residency training-who were actually my classmates-were
highly multicultural in background: Many came from places such as the Ukraine,
Romania, Crete, Spain, Ireland, and Cuba. The rest hailed from the USA,
especially large cities such as Boston and Chicago. Collectively, we residents
were a powerhouse of knowledge and dedication, and we all seemed possessed of a
compelling urge to provoke and to seek the unknown.
On occasion, however, one
or another of my classmates would engage in practice with a patient that
befuddled me. For example, there was the case of a resident from Ireland. He
was reported by a member of the Nursing staff, on my assigned inpatient ward,
to the Chief of Service. She reported him because a woman patient, who was
under his charge, was refusing food, burning her face with cigarettes, and
lying on the floor with her arms outstretched and legs placed together,
mimicking Christ on the Cross.
The nurse was concerned that the patient might
die from starvation, and so the Chief of Staff queried my classmate about the
situation. His reply was that he wanted to analyze the behavior of the patient
under a condition of deprivation. After a brief conference among the staff, the
patient was given intravenous fluids immediately-much to the consternation of
my classmate! The staff based its decision on the logic, "Better a live
schizophrenic than a dead one." My classmate was thus denied the right to
analyze the patient. His zeal, though exemplary, was thwarted. He seemed too
blind to notice that his "curiosity" posed a threat to the patient's health. As
I watched this event unfold, I wondered how one's conviction could be so
steeled, with no means for compromise.
After a year of supervision and lectures
on Group Therapy Dynamics by a senior staff member, my class-for reasons not
very clear to me-decided to gather together on a regular basis, to polish up
on what we then called "group therapy." This proved to be memorable, as someone
in the group said to me, "You have a tendency to let things `happen'." Over the
years, I have thought many times how close that observation was to the truth.
Whether this group exercise in "free speech" was enriching, overall, I do not
know. It continued, however, well-attended, through most of my time at the
Institute.
During my residency, in addition to the time I spent at the Illinois
State Psychiatric Institute, I was required to spend 6 months in a psychiatric
state hospital that housed longterm patients. Immediately upon seeing the
environment and patients, most of whom had been there for many years, I was
reminded of the hospital in the movie One Flew Over the Cookoo's Nest, complete
with a power- driven Head Nurse.
From these experiences, I felt comfortable,
among other things, dealing with acute patient problems. Perhaps this is why,
as I was about to end my residency, I applied for employment at the Crisis
Intervention Program at Harvard-the only place to which I applied. Why did I
only apply there? The idea of Harvard was appealing, to be sure, and the
prestigious institution had position with a learning aspect to it, which I
wanted. Also, I believed there was an opportunity to do community-oriented
psychiatry at Harvard. And I had heard about the late Dr. Erich Lindemann, who
conceived and formulated the Program there with great vision. In retrospect, I
guess I was gambling with my immediate future at the time, by limiting myself
to one institution. My gamble paid off, however: Harvard accepted me with a
Fellowship in Community Psychiatry.
I was thus about to move east and change my
course-unlike almost all of my classmates, who stayed in Illinois to fulfill
a further commitment to that State. Only one other alumnus I was aware of left
Illinois, for Montreal, Canada.
During the initial period of psychological and,
then, physical disengagement from the Institute and state of Illinois, I found
myself quite alone. Along with this feeling of solitude, I realized that the
group I left behind was, indeed, a formidable nutritive source, which would not
be available to me anymore.
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