“Do any of you have children?” the patient’s mother asked each of my team members during rounds. I (STG), as the attending, quickly jumped in and mumbled, “Yes, I have (as a foster parent),” and redirected the conversation back to the medical management of her child.

It was not until a week later, when I was attending a talk on microaggressions, that I realized my team members may have perceived the mother’s question as a microaggression, since it implied that care for her child would be different if we were parents. Why did it take me so long to recognize this potential microaggression?

Introduction

There has been an explosion of Asian (American) representation in mainstream media in the last several years. It was exciting for the Asian community when Marvel produced Shang-Chi and the Legend of the Ten Rings, and when Michelle Yeoh became the first Southeast Asian actress to be nominated for and win Best Actress for Everything Everywhere All at Once (EEAO) in 2022.

The most affirming part of seeing the Asian American story told on screen was realizing we were not alone in our childhood experiences. Watching EEAO, I (STG) gasped when Michelle Yeoh’s character said to her daughter, Joy, “You are getting fat!” not out of shock but to say, “It’s not just me!” The constant comments about her daughter’s weight instantly brought me back to when my mother scanned me up and down as I approached her at the airport after not seeing her for several months, and her first words were, “Oh good. You’ve lost some weight.” The objectification and harsh judgment I experienced is, heartbreakingly, a universal experience for many Chinese Americans. As I watched EEAO, I felt liberated in finally seeing an acknowledgment of the intergenerational trauma I’ve experienced my entire life.

Intergenerational trauma: What is it? How does it affect Chinese Americans?

Intergenerational trauma describes an emotional or psychological trauma experienced by a group of people that affects the health and well-being of individuals in successive generations. Although immigration is often catalyzed by parents’ hope of a better future for themselves and their children, the very experience of immigration and its consequences—alienation, foreignness, discrimination, racism, and rejection—all instill lasting, damaging psychological trauma on the individual. Oftentimes, this trauma goes unrecognized but may result in microaggressive behaviors.

For children growing up with parents who are affected by intergenerational trauma, their parents’ microaggressive and macroaggressive behavior are often wielded without explanation. The rift toward intergenerational understanding of the causes and manifestations of historical trauma is driven deeper by ideologies that promote a “don’t air out your dirty laundry” rhetoric, silencing cathartic conversations before they even happen. Children are left with only speculations about their parents’ unexplained behavior; often, the result is placing blame inwardly. A toxic cycle of hurt and resentment is thus perpetuated. In EEAO, Joy articulates this to her mother through a tear-thickened voice: “I don’t want to hurt anymore. And for some reason, when I’m with you, it just hurts the both of us.”

Microaggressions and intergenerational trauma

How did microaggressive culture as a result of intergenerational trauma in Chinese American communities become so normalized? Deeply rooted cultural attributes provide some insight. Two-thousand-five-hundred-year-old Confucian teachings discourage open displays of emotions to avoid exposure of personal weakness. Furthermore, in patriarchal family models, women were expected to uphold rigid gender roles of quietness and obedience, which undoubtedly normalized a permissive culture toward microaggressions for Chinese American women. Collectivist culture has also been associated with greater emotional suppression compared to individualistic cultures. Finally, filial piety, which involves respecting, obeying, and caring for one’s familial seniors, is widely practiced in East Asian cultures. Unfortunately, filial piety perpetuates tolerance of microaggressive and macroaggressive behavior, as more senior figures are given agency to inappropriately comment on the personal aspects of younger individuals.

Did growing up in a household where microaggressions were constantly committed contribute to why I (STG) did not realize the mother’s comments on rounds were perceived as a microaggression by several of my residents? Was the shame I was feeling about motherhood so uncomfortable that I was quick to redirect conversation and failed to be an upstander to address the inappropriateness of the comment?

As a result of our internalizing microaggressions committed within our families as “the norm,” we may inadvertently demonstrate tolerance for microaggressions in our work environments. This further feeds into the “model minority” myth and the notion of a quiet, hard-working, upstanding employee who never complains.

Recognizing microaggressions in medicine

As a result of intergenerational trauma and historically entrenched cultural practices, microaggressive and macroaggressive behaviors have become normalized in the Chinese American psyche. If true, how can we recognize and speak up against microaggressions in medicine?

First, it’s important to recognize the influence that our Chinese culture has on the recognition of microaggressions. While we may not be able to challenge our elders when we are the victims of microaggressions, we cannot perpetuate this culture in our workspaces. Education about recognizing microaggressions is vital, as detailed in the book Microaggressions in Medicine. It is also necessary to attend workshops and seminars to gain practical skills on how to be an upstander who actively addresses microaggressions shortly after they are committed.

To achieve a deeper understanding of how our cultural history impacts our view on microaggressions, it’s important to discuss this topic with others of Chinese descent. The first time STG acknowledged how the trauma experienced within her own family affected her perception of microaggressions was through discussion with LC, a pre-health undergraduate student doing a research rotation in her lab; for LC, this was also her first discussion on intergenerational trauma affecting microaggressions, as STG was the first Chinese American mentor she’d ever had. We must learn to have open conversations on the biases we have so that we can learn to mitigate them.

Despite the generationally entrenched trauma that our parents, and our parents’ parents, have experienced, it’s not impossible to break the cycle. Through exposure, conversation, therapy, and support, we can work together to create a more accepting, empathetic, and encouraging environment for ourselves and future medical professionals.

The authors are grateful to Drs. Samir Shah and H. Rhodes Hambrick for their thoughtful comments to enhance this piece.

Lucy Cheng is a predental student. Sonya Tang Girdwood is a pediatrician.