COVID-19 and the Race That Nobody Sees

I am both the Other to white America (and thus a threat to its health), and part of the White establishment and a threat to other Americans. At least, that has been my experience since February when the “Chinese” virus arose and my experience after the killing—no, murder—of George Floyd. COVID-19 and the death of George Floyd have been revelatory in the biblical sense (apokalypsis): they unveil the nature of a reality. They unveil the reality of “Asian American” as a race.

Take COVID-19. Asian Americans have been experiencing an uptick as targets of racial discrimination, even racially motivated violence.[1] When I was waiting in line at the grocery store, an elderly white woman in front of me kept looking over her shoulder at me with suspicion and inching away. She did not say a word, but I assume her suspicion was heightened by my being a mask-wearing Asian. Coupling COVID-19 with Asian American race makes for one implication: Asian Americans are perpetual foreigners and are not welcome.

Take the horrific killing of a black man, George Floyd, at the hands of police brutality by a white officer, while Tao Thao, an Asian American police officer stood guard. Numerous Asian Americans have showed solidarity with the Black community in the fight against racial injustice. Going one step further, some Asian Americans have called on using their “white” privilege to advocate on behalf of the Black community. Here is another implication: racial injustice is imagined to be a binary problem of black and white.

When juxtaposing COVID-19 and George Floyd, where do Asian Americans fit? When the occasion fits the dominant cultural moment, Asian Americans are either “Asian” and therefore Other as a threat from the outside or “white” and therefore the powerful insider.

In Disciplined by Race, Ki Joo Choi, an Asian American Christian ethicist, argues that being Asian American is a deeply racialized existence (not cultural), forced to make a binary choice either to be white or to be a domesticated Asian for some social end defined by the dominant culture, such as being the “model minority.”[2] The former is impossible to embody while the latter diminishes what it can mean to be Asian. Thus, being Asian American forecloses the possibility to be something other than what the dominant culture prescribes in either manifestation.

The son of a physician, I was born and raised in Greenville, Texas, population 23,000 about one hour away from Dallas. My parents are immigrants from Thailand and ethnically Chinese. We were the first Asian family in town. I proudly call myself Texan-Thai-Chinese (in that order). While growing up, I was the target of racial slurs.

I remember waiting in the lunch line in fifth grade when another student asked me, “Do you know kung fu? Do you know Bruce Lee?” When I was in high school, a new girl had moved into town. Immediately after we first met, she blurted out with a mocking Japanese accent, “Ohhh, sexy girlfriend,” quoting the character Long Duk Dong from the 1984 movie Sixteen Candles. Such ignorant remarks stung with a realization: I was a perpetual foreigner in my own hometown. Ignoring little comments becomes difficult because these racial slurs build up over time. I learned that I was different from everyone else and did not fit in.

Feeling like a perpetual foreigner was not confined to my hometown—I also felt like a foreigner in my own skin. As a second-generation Asian American, I feel my identity is split between two cultures to which I do not fully belong. The racial slurs were constant reminders that I was different than everyone else because I looked foreign. (The banality of racism manifests in questions like “No, where are you really from?”) When I visited my extended family in Thailand, everyone looked like me, but I did not feel like I fit in because I could hardly speak the Thai language. If my body was not American enough (read: white), and my culture was not Asian enough, then what was I?

I did well in school. I internalized my parents’ expectations that with academic success you can live a good life. When I was growing up, my parents identified three viable career options: medicine, law, or engineering. No other possibilities could be imagined. If you go to an elite school and get a good job, then you can provide for your family, so the cultural logic goes.[3] I wanted to follow my father’s example and become a physician. I dreamed of going to an Ivy League caliber school, having internalized the dream from my parents who equated success with the Ivy League. If I could not be a full Asian culturally or a full American bodily, then my identity would be rooted in academic success. Those high school dreams died when I was rejected by all of the Ivy League caliber schools. Since I did not meet the internalized family expectations nor the standards of my own self-identification, I felt like a failure and was ashamed.[4]

One might think that becoming a physician alleviates Asian American racial dynamics, but the culture of medicine is not immune to racial microaggressions. As a medical student, I enjoyed rotating at the VA hospital because of the veteran population. However, immediately after I walked into a patient’s room, a veteran told me, “Go away. I don’t want a Jap doctor.” Despite my gratitude for this veteran’s service to America, I was not considered American enough to be involved in his care. My older brother, also a physician, was told by a patient at the VA, “I don’t want a doctor from the Viet Cong.”

Medical culture and Asian American culture share remarkably similar values that work to exacerbate the invisibility of Asian American experience in medicine. Asian American cultural values in academia and the workplace can be stereotypically summarized as: work hard, don’t rock the boat, don’t trouble other people. Out of respect for and obedience to one’s parents, these values are internalized. The expectation is that all problems are solved with hard work and self-reliance.

In the culture of medicine, a similar work ethic reigns. In the face of tiredness and fatigue, medical students and residents are encouraged to suck it up, work harder, and “be more efficient.” Medical trainees are not taught to ask for help but rather are held to the ideal that a good physician is self-sufficient, efficient, and resilient. When Asian American culture meets the culture of medicine, the shared values mutually reinforce each culture. The Asian American/medical cultural synthesis teaches trainees and physicians in the midst of struggle to keep your head down, work hard, don’t seek help, and don’t bother anyone.

However, these values are not unique to the culture of medicine. They are equally valued in law and engineering, the other professional options made available to me. This cultural synthesis can be toxic for Asian Americans in high-pressure professions with cultural prestige. To illustrate, look at the data on mental health in physicians and the Asian American population. Asian Americans use mental health services less than the general population (8.6% vs. 17.9%).[5] Suicide is the ninth leading cause of death among Asian Americans, compared to tenth among Caucasians. A high level of identification with one’s ethnic group is associated with lower rates of suicide attempts.[6] From my own experience, being a second-generation Asian American can lead to lower identification with one’s ethnic group, feeling neither fully Asian nor fully American. Unfortunately, this dynamic has not been studied in Asian American physicians.

It is a well-established fact that the rate of suicide is higher in physicians than the general population.[7] But the cause for the increased rate is unknown. Being Asian American has not been considered a risk factor for physician suicide in the medical literature. However, I would like to highlight a study on suicide among U.S. physicians that analyzes data from the National Violent Death Reporting System.

When looking at various factors associated with the likelihood of the suicide victim being a physician, Gold et al. found that race was statistically significant. Physicians in the “Other/Missing” race were three times more likely than Caucasian physicians to commit suicide.[8] It is true that the racial category of “Other/Missing” cannot delineate whether the higher likelihood is due to being Asian, Hispanic, etc. Yet, the most telling thing is what Gold et al. do not say in the discussion section. The study authors do not even entertain the question that race could be an important factor in physician suicide. They do not explore the possibility of breaking down the racial category “Other/Missing” to investigate whether, perhaps, Asian American cultural dynamics could be a factor in physician suicide. This is a gross oversight.

It is my hypothesis that the Gold study is a symptom of a larger problem that Asian American physicians are an invisible group in medicine. This is despite the fact that Asians comprise 5.6% of the U.S. population[9] yet make up 20% of all U.S. medical school graduates.[10] If Asian Americans feel pressure to become a physician (presumably resulting in many Asian Americans becoming physicians who do not really want to), if Asian Americans on the whole underutilize mental health services, and if physicians in general have a higher rate of suicide, then such a significant finding about race and physician suicide should be investigated. Asian American mental health in medicine is not understudied; rather, the issue is not studied at all.

It is not studied because discussion about the Asian American physician experience does not exist.[11] This is the fundamental problem. While Asian Americans face no racial disparities in terms of admissions and representation in academia, there are ocular disparities of racial invisibility due to unconscious bias.[12] Wesley Yang says it well: Asian Americans occupy a liminal place as “an ‘honorary white’ person who will always be denied the full perquisites of whiteness . . . a nominal minority whose claim to be a ‘person of color’ deserving of the special regard reserved for victims is taken seriously by no one.”[13]

And yet, overemphasizing “Asian American” as a racial category in the effort to go beyond the black-white racial binary intensifies the racialization that it is meant to overcome. Since the dominant culture has racialized “Asian American,” being “Asian American” dissolves one into the dominant white identity or into the margins as Other. Because of my own cultural and familial history, I am also Chinese American and Thai American and Texan. But reducing my self-identity to the Asian American race destroys my unique embodied particularity and the rich textures of my narrative self-constitution.

The destruction of embodied particularity can also be applied to race in general and the White-Black racial binary in particular. If race is socially and culturally constructed, and if we reduce ourselves to our race, then the implication is that to be fully “White” or fully “Black” or even fully “Asian American,” one must sacrifice embodied particularities—diverse bodies, histories, practices, and stories—for a racial nominalism of Whiteness or Blackness or Asian American-ness. Racial particulars become universalized, empty categories.

As a way to resist the universalization of race, behold the Incarnation of Jesus Christ. In Christ the universal and the particular hold together. Christ has divine and human natures, both of which are universal. However, universals do not save us, only a Savior—a particular person—saves us. The universal natures are unified in the concrete, particular person of Jesus of Nazareth. The God-man is a particular person with a particular history (lived in the first-century), particular culture (Jewish), particular location (from Nazareth), particular political climate (occupied Palestine under Roman and Jewish rule), and particular relationships (Joseph, Mary, and the disciples). If we do not have Christ’s embodied particulars, we do not have Jesus of Nazareth. We do not have a Savior. We do not have the gospel.

I say all of this ultimately not as an Asian American nor as a physician, but as a Christian and as a theologian. I am chiefly identified not by race nor by profession, but to whom I belong: I wear God’s name of Father, Son, and Holy Spirit. So I remember my baptism. In Christ there is neither Jew nor Greek (Gal 3:27-28). However, the water that unites me to Christ does not wash away my embodied particularity. In the early Church, there were disputes about the distribution of food between Hellenist and Hebrew widows, necessitating the creation of the diaconate (Acts 6:1-3). Despite being disciples of Jesus, they were still Greek and Jewish. Likewise, being Asian and American are, in part, constitutive but not exhaustive of my self-identity.


[1] For example, see Helier Cheung, Zhaoyin Feng, and Boer Deng, “Coronavirus: What attacks on Asians reveal about American identity,” BBC News, May 27, 2020, https://www.bbc.com/news/world-us-canada-52714804.

[2] Ki Joo Choi, Disciplined by Race: Theological Ethics and the Problem of Asian American Identity (Eugene, Or.: Wipf & Stock, 2019).

[3] OiYan Poon, “‘The Land of Opportunity Doesn’t Apply to Everyone’: The Immigrant Experience, Race, and Asian American Career Choices,” Journal of College Student Development 55, no. 6 (2014): 499–514; Mark Safferstone, “Motivation of Asian Americans to Study Medicine: A Pilot Study,” Academic Leadership: The Online Journal 5, no. 1 (2007): 11.

[4] Lei Wang, Y. Joel Wong, and Y. Barry Chung, “Family Perfectionism, Shame, and Mental Health among Asian American and Asian International Emerging Adults: Mediating and Moderating Relationships,” Asian American Journal of Psychology 9, no. 2 (2018): 117–26.

[5] Jennifer Abe-Kim et al., “Use of Mental Health–Related Services among Immigrant and US-Born Asian Americans: Results from the National Latino and Asian American Study,” American Journal of Public Health 97, no. 1 (2007): 91–98.

[6] Janice Ka Yan Cheng et al., “Lifetime Suicidal Ideation and Suicide Attempts in Asian Americans,” Asian American Journal of Psychology 1, no. 1 (2010): 18–30.

[7] Eva S. Schernhammer and Graham A. Colditz, “Suicide Rates among Physicians: A Quantitative and Gender Assessment (Meta-Analysis),” American Journal of Psychiatry 161, no. 12 (2004): 2295–2302; Steven Stack, “Suicide Risk among Physicians: A Multivariate Analysis,” Archives of Suicide Research 8, no. 3 (2004): 287–92.

[8] Katherine J. Gold, Ananda Sen, and Thomas L. Schwenk, “Details on Suicide among US Physicians: Data from the National Violent Death Reporting System,” General Hospital Psychiatry 35, no. 1 (2013): 45–49.

[9] U.S. Census Bureau, 2010 Census Redistricting Data (Public Law 94-171) Summary File, Table P1.

[10] KFF, “Distribution of Allopathic Medical School Graduates by Race/Ethnicity,” The Kaiser Family Foundation’s State Health Facts, The Henry J. Kaiser Family Foundation, accessed June 4, 2020, https://www.kff.org/other/state-indicator/distribution-by-race-ethnicity/?dataView=1&currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

[11] To my knowledge, there is nothing published in the medical literature about the Asian American physician experience. In fact, I attempted to publish an ancestral version of this piece in various medical journals, only to be roundly rejected within 24 hours of submission. I suspect that those rejections prove my thesis that Asian Americans are an invisible race in medicine.

[12] Helen Ngo, “Racist Habits: A Phenomenological Analysis of Racism and the Habitual Body,” Philosophy and Social Criticism 42, no. 9 (2016): 847–72.

[13] Wesley Yang, The Souls of Yellow Folk: Essays (New York: Norton, 2018), xiv.

Featured Image: Drawing used by kind permission of Daniel Mitsui, Our Lady of Perpetual Help (prints available for purchase), 2012, ALL RIGHTS RESERVED. You can visit Mr. Mitsui's artwork page and store here

Author

Kimbell Kornu

Kimbell Kornu is assistant professor of medicine and health care ethics at Saint Louis University and is a practicing Palliative Care physician. He has published widely in the philosophy and theology of medicine and is currently working on a book that traces the genealogy of medical knowing back to the origins of Western medicine through the lens of anatomical dissection.

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