Why Asian Americans never seem to get sick

Why Asian Americans never seem to get sick

 Office of the Dean April 5, 2019

A Q&A with James Kyung-Jin Lee, associate professor of Asian American studies

Tell us about your current book project.

My book project explores the intersections of race, illness, embodiment and narrative. Specifically, I am interested in the ways in which the contemporary experience of illness, and the ways that Western biomedicine confronts illness and the persons of ill embodiment, compels new forms of storytelling. I'm interested in particular in how Asian Americans figure in the landscape of illness and healthcare in part because of the particular ways that they have entered both the popular, critical, and scholarly imaginations of this landscape. If you were to look at narrative representations, you'd think that Asian Americans rarely get sick and even more rarely died. (For the record, Asian American death rates mirror that of other Americans). Conversely, Asian Americans have in many ways become spokespersons about contemporary illness in the U.S.: they are more often than not physicians and surgeons and even chief spokespersons for the medical establishment: think here of the current U.S. Surgeon General (Vivek Murthy), CNN's chief medical correspondent (Sanjay Gupta), and bestselling authors about U.S. biomedicine (Atul Gawande, Siddhartha Mukherjee, Pauline Chen). What does this skewed representation—a preponderance of (healthy) Asian American doctors who are writing as doctors, a dearth of Asian Americans writing about ill embodiment—mean? What are the possible social, ethical, and political consequences of this narrative asymmetry, not only for Asian Americans but also for Americans in general, not only for the sake of cultural visibility but also for public policy?

Can you trace this narrative of Asian Americans defying illness or give us a sense of its trajectory?

The preponderance of Asian American medical narrative and the dearth of stories about Asian American illness can be understood broadly in two ways. The political economy not only of the U.S. but also of developing countries in Asia over the last half-century, produced a series of push/pull conditions that sent physicians and other healthcare professionals overseas to the U.S. As an example: South Korea built medical and nursing schools in the aftermath of the Korean War specifically to train young doctors and nurses for export to the U.S., with curricula modeled after U.S. schools to facilitate easy licensing. This occurred around the very time that the U.S. transformed its immigration policy to a new mode of state selectivity, displacing national origins for employment-based preference at the very moment that demand rose for skilled healthcare workers, such as the passage of Medicare and Medicaid in 1965. Pass this particular mode of social mobility to second generation (U.S.-born) Asian Americans, you can imagine how it became an easily reproducible narrative into which Asian Americans could project desire. In addition, the physician’s story reinforces and distills the prevailing social narrative of Asian Americans as model minorities, a narrative that has held sway in the U.S. imagination for more than 50 years. While the representation of Asian Americans as model minorities is one of economic and educational mobility, I suggest that there is a coterminous ongoing passionate attachment to fantasies of indefinite health that is baked into this notion of the Asian American model minority. Asian American physician narratives buttress this connection, for which group is more poised to be a non-sick person than the professional existentially and socially-produced to diagnose and cure what ills you? And in turn, why would you write an illness narrative that might disrupt the overwhelming optimistic vision of Asian American model minority health?

What are some of the political and ethical consequences of this narrative asymmetry?

For one, this asymmetry means that the illness and death that does occur within the Asian American community are hidden, buried, unheard, and unrecognized. Such lack of recognition can lead to immeasurable suffering, a kind of suffering beyond pain (but which may include pain), which in turn can have profound impacts on relations within and among Asian American families. There are also policy implications: Asian Americans contain communities least likely to produce advanced healthcare directives for themselves or loved ones and among the most likely to resort to “heroic” measures at the end of life, which may prolong physical life but at a great expense: ICUs and the like are costly and tortuous. Despite its great advances, Western biomedicine’s impulse to prolong human life indefinitely has produced deleterious outcomes. The Asian American rendition of this relationship to contemporary biomedicine takes this cultural logic to its limit, and my project wonders if in these narratives we see not just biomedicine’s limits but also its potential undoing.

What sparked your interest in this topic?

I spent 400 hours working as a chaplain intern on the oncology and medical surgery floor of a hospital in downtown Los Angeles in the summer of 2009. It was during those ten weeks that I discovered that the more than twenty years of socialization to become an academic were more or less useless when encountering people beset with contingency, fragility, vulnerability, and mortality. It was perhaps this crucible of experience that helped me see how profoundly disruptive illness and disability can be in how and why we tell stories—and how transformative an honest assessment of what bodies tell can be.

Where would you point us for further reading?

One book that got me through that summer in 2009 was Arthur Frank’s The Wounded Storyteller, and I still turn to it for insight. I think for Asian Americanists, Mel Chen’s Animacies and Rachel Lee’s The Exquisite Corpse of Asian America will help people make this turn to race and embodiment. In terms of memoir, I would probably start with Anatole Broyard’s Intoxicated By My Illness and Audre Lorde’s The Cancer Journals. Brandy Worrall’s What Doesn’t Kill Us is that rare illness memoir written by an Asian American so very worth reading.

Originally published September 25, 2016 in UCI Humanities' "Body & Wellness Magazine"