I (JF) was drowning in the chaos of that early afternoon on the adolescent inpatient psychiatry unit. It was my first month on the child and adolescent psychiatry wards; to say that I was brimming with enthusiasm is to put it mildly. At that moment in my training, everything was new—every case, every demographic, every treatment, and every diagnosis.
I am an Ecuadorian American physician who immigrated to the USA as a young child. I was born in the city of Loja, but it was in the multicultural city of Elizabeth, NJ, that I became bilingual. I give the example of language and bilingualism because Spanish was one of those ever-evident variables used by others to label people like me. But life and labels were not static, and it was during psychiatry residency that I abruptly realized I had lived most of my life in the USA, not in Ecuador. As many Latinxs tell me, I was becoming aware of the complexities and the implications of my pluricultural identity . I was neither Ecuadorian nor American, but somehow, I was both. This identity limbo was even more challenging in medical and graduate school where few people had been in my shoes. To make things even more confusing, the swift changes in my privilege as a physician upon the start of psychiatry residency only exacerbated the conflicts regarding my identity. Certainly, I was a multicultural psychiatrist in training .
That afternoon in the psychiatry wards, I evaluated a female pediatric patient who happened to be from Ecuador. She had a history of sexual trauma and a complicated legal situation due to differences in laws between both countries. I was appalled by my lack of familiarity with the patient’s social, legal, and cultural history. I felt ashamed about my evident ignorance when the patient discussed her trauma with the nuances she would share with, say, a compatriot. She felt that perhaps I would understand. On the contrary, I felt like a fraud, a familiar face with no substantive formulation to help my patient. It was a moment of truth for a painful realization: My acculturation in American society and my isolation from my own Ecuadorian community during medical training had produced glaring deficits in my cultural understanding about the people who were once my own childhood neighbors.
Another patient arrived that afternoon, a male adolescent who also happened to be Ecuadorian. This new patient was older, from a different region of Ecuador, and had a history of trauma and substance use. I realized that both patients were having quite different experiences as Ecuadorian Americans. Their intersectionality was different. I felt this was the perfect opportunity to grow. I had to start fixing my newly perceived deficits in my definition of diversity and learn to see the nuances of different life experiences beyond shared nationality. Eager to make amendments, I asked my attending if I could follow this new patient. My attending replied, “Sure, this would be a good case to see, but I think it would be better to have more diversity in the patients you follow.”
My supervisor’s words hurt me. I felt that the diversity of my native Ecuador was somehow “insufficient” to qualify for a “bona fide American diversity.” At that moment, I felt that I was “too Ecuadorian” to see another Ecuadorian, despite my lack of familiarity with the experiences of people like myself in the American mental health system.
In other situations, I experienced another side of stereotypical assumptions based on a strange list of variables that others thought they saw in me, which presumably collectively measured my level of “Latinoness.” For example, Latinx residents often feel the push to evaluate Latinx patients because of an apparent familiarity despite lack of training with these US populations.