According to Garrison Keilor, all the children in Lake Woebegone are above average. Regina, Saskatchewan, the less than amazing prairie city of 65,000 where I grew up, outdid Lake Woebegone. In Regina, everybody was better than everyone else. The Catholics were better than the Protestants and both were better than the Jews. The Russians and the Ukrainians looked down on the Germans their countries were fighting, and finally beating, in World War II. A British accent was an automatic claim to exceptionality. Nobody thought much about the three or four Chinese families who ran the town’s hand laundries. One thing everybody agreed about: if you went into the Aboriginal part of town, you deserved whatever trouble was sure to come your way. I don’t know what went on inside the other communities that were the most picked on, but Jewish parents like mine always reassured their children that we were the best: we were, after all, God’s chosen people. No doubt the Chinese immigrant families and the Aboriginals sharing the bottom rungs of the town’s social ladder with us told their children similar things.
Aside from being ugly, there was, it seemed to me, something absurd about racial discrimination. Years later, when I became more reflective, I looked back on those early years with sadness. Those mutual hatreds robbed everyone. Life could have been so much better if we had all been allowed to be proud of who we were, and encouraged to share our cultures, rather than fight about them.
Medicine attracted me during my undergraduate years at the University of British Columbia, partly because it seemed a way to do some good in the world, partly because it was a secure way to make a living. To tell the truth, too much of the learning was rote, too much of the teaching authoritarian. A brilliant, charismatic and provocative professor of psychiatry relieved the boredom. He offered me summer jobs with his research team, and, the more I got to know about the field, the more I liked it.
It would take too much detail to explain why I ended up doing a residency in psychiatry at Duke University in Durham, North Carolina, rather than going to New York as I had always thought I would. I’m glad I did go there because the 1960’s were exceptional times in the old South.
My residency began in July of 1961. I drove to North Carolina in the first car I ever owned. Having characteristically over-estimated what I could accomplish, I had decided to drive non-stop from New York City to Durham. By the time I got to West Virginia around 11 o’clock on a dark, rainy night, it was clear that I had made a mistake. I started looking for a motel, but they all had No Vacancy signs. Finally, though, I saw one that had vacancies. I pulled up, walked to the front desk and asked to register. The man at the desk seemed a bit hostile and more than a bit suspicious. He said to me, “You can’t stay here.” I said, “Why not? Don’t you have rooms?” “Sure we do, but not for you. Did you see what the sign out front said?” I had noticed a sign that didn’t make a lot of sense. It said “Colored.” It was late, I was dazed and exhausted and I was a naïve Canadian. I had thought maybe they were advertising that they had color TV. The light finally came on. I said, “You mean I can’t stay here because I’m white?” “That’s right son,” was the final word. I ended up sleeping in my car.
Those were tumultuous years. They were the years of sit-ins and freedom rides, of Ku Klux Klan murders, and, finally, of desegregation. Duke University Hospital, which used to have washrooms labeled “men,” “women,” and “colored,” painted over the word “colored,” and substituted “staff.” To considerable fanfare, Duke University admitted its first black medical student. Far more quietly, they decreed that he was not to examine white patients: he had to do his clinical work at the black-only hospitals.
It seems hard to imagine today, but, in the 1960’s, most chairs of psychiatry in the United States were occupied by psychoanalysts. Everything that used to be called neurosis could be explained as some variation of an unresolved oedipal conflict. If the patient was well enough educated, he or she could be treated with psychoanalysis or psychoanalytically oriented psychotherapy.
Outside the Department of Psychiatry, the civil rights movement was changing the way people thought about themselves and about each other, sociologists and politicians were talking about the brutalizing effects of poverty and blocked ambition, and psychiatrists like Franz Fanon were writing about the psychological legacy of apartheid and colonialism. Inside, nevertheless, everything went on as before. Unhappiness was a product of frustrated internal drives, civil rights leaders were all rebelling against their fathers, poverty was not a cause, but a product of mental weakness, and people like Fanon were psychologically disturbed radicals.
There were oases that offered intellectual refreshment. One of these oases was a brilliant Chinese analyst named Bingham Dai. Because he wrote so little, Bingham is not nearly as well known as he should be. The problem is that he was too much of a perfectionist: he once told me that he was irritated by an editor who was rushing him to finish a manuscript. I asked him how long he had been working on the paper. He admitted that it had been seven years.
Born in China, Bingham received a PhD in Sociology from the University of Chicago where he had been trained as a psychoanalyst. At Duke, he offered the first year residents a seminar in dream interpretation. At our first session, Bingham told us about a dream presented to him by a patient and asked us to analyze it. The night before her only daughter was to be married, Bingham’s patient dreamed she was wandering about the city picking up pieces of coal. What did that mean? We were all sure we knew. Some of us opined that she was depressed about being abandoned, symbolized by the blackness of the coal. Others felt she was jealous of her daughter’s happiness, and wanted to blacken her with coal. Bingham listened to all this wisdom and then asked: “Do you think it might have been important to ask me where I saw this patient?” Well…yes, we all agreed that might have been important. So Bingham told us that it had been in Taiwan. We all nodded sagely. “Why is that important?” he then asked us. We didn’t know. “In parts of China, coal is a symbol of good luck.”
One day, Bingham suggested that I read Alexander Leighton’s new book, My Name is Legion. By now, I knew how valuable it would be to follow his advice.
The book was a brilliant synthesis of how development, the internal life and the external environment interact to frustrate, or to promote human happiness. I was so impressed that I flew to New York City, walked into Leighton’s office at Cornell medical school and asked him if I could become his research fellow. I think that my chutzpah amused this rather reserved gentleman. He agreed to take me on and later, when he assumed a chair of Behavioral Sciences at the Harvard School of Public Health, he invited me to join him as an Assistant Professor. For the next ten years, I worked with Alec on his famous Stirling County Study, one of the first psychiatric epidemiology surveys to be undertaken and one of the first to reveal the hitherto unsuspected burden of mental disorder in communities. My major responsibility was to supervise a sub-study of a panel comprised of 60 people with psychiatric disorder and 60 who seemed to be successful and happy. Some of my earliest publications, which come from this period of work, deal with defining and trying to measure successful adaptation.
Alec was also one of the pioneers of cultural psychiatry, bringing his rigorous research methods to Nigeria where he worked with people like Adoye Lambo to produce the well-known work, Psychiatric Disorder among the Yoruba. Alec generously supported my own ambitions by introducing me to the famous researcher, theoretician and innovator, Henri Collomb. Alec also permitted me time away from Boston during which I helped Henri design and carry out a study of psychiatric disorder among the Serer of Senegal, West Africa, and about the effects of migration from rural villages to the city.
An award from the Macy Foundation made it possible for me to spend a sabbatical year in France and Senegal completing the study and writing up the results. Publications based on that work deal mainly with the failure to confirm the hypothesis that the profound social change inherent in rural to urban migration would invariably create mental health risk. Social change alone was not inevitably accompanied by mental health risk. However, social change combined with blocked opportunity created increased risk not only for mental disorder but for elevated blood pressure.
In 1975, I decided to return to Canada, and took up a professorship at the University of British Columbia. Thanks to a National Health Research Scientist award from the Canadian government, I was able to protect myself against too many clinical and administrative responsibilities and concentrate on research. In 1981, two UBC colleagues – Dr Phyllis Johnson and Dr. Richard Nann — and I initiated the Refugee Resettlement Project, a study of a large community sample of Southeast Asian “Boat People” who fled that troubled peninsula between 1979 and 1981, and were resettled in Vancouver, British Columbia. This became a ten-year longitudinal study which I believe is the longest-lived study of its kind conducted to date. Publications based on this work deal with the supportive mental health effects of the like-ethnic community, changes in employment patterns over time, and differential opportunities for men and women. My early observations about racial discrimination no doubt had something to do with my inclusion of its effects on the mental health of newly settling refugees in the study, as well as an interest in the effects of ethnic identification on mental well-being. I think that our research on the defense mechanism of suppression as a coping strategy in the aftermath of catastrophe is one of the more interesting and original parts of this research. The idea arose out of observing the way in which people in refugee camps in Thailand and Hong Kong handled their perceptions of time while they were waiting to be relocated to Canada. We developed a simple test of time perception that could be administered as part of our epidemiological surveys. I summarized many of our findings in a book called Strangers at the Gate. I received a Rockefeller Foundation Resident Scholar Award in 1995, which made it possible to spend a responsibility-free month at a beautiful estate in Bellagio, Italy, where all I had to do was concentrate on writing my book. It was published in 1999. My colleagues and I are, however, continuing to mine this seemingly inexhaustible trove of data and to publish our results in journals.
While the Refugee Resettlement Project was going on, I was also funded by the National Health Research Directorate Program of Canada, the National Institute of Mental Health and the WT Grant Foundation to carry out the Flower of Two Soils, a study of mental health and academic performance among Aboriginal children on two United States reservations and two Canadian reserves. I was very pleased to be able to work with outstanding US colleagues, including Spero Manson, Bill Sack, and James Shore, on this project. One of our main publications showed that teacher expectations subsequently affected children’s mental health and performance, and that children’s performance in turn predicted future teacher perceptions – a classic picture of reciprocal cause and effect, and a demonstration of the power of teachers to affect the mental health and academic futures of their students.
Nowadays, there is much talk about making research relevant to policy and practice. In 1986, I was privileged to play a small role in the policy world by chairing a federal government task force on the mental health of immigrants and refugees in Canada. We received written depositions, conducted oral hearings over the course of two years, and then, in 1988, issued our task force report called After the Door Has Been Opened. It contained a series of recommendations that we were sure the government would be eager to implement. Instead, my colleagues and I learned how slowly and painfully change comes about. Although I don’t think that the federal government ever directly implemented any of our recommendations, the report did have its uses: people tell me that even today they use it to advocate for change within local mental health institutions and at different levels of government.
In 1991, I accepted an invitation from the University of Toronto Department of Psychiatry to found the Culture, Community and Health Studies Program, an interdisciplinary research initiative that I continued to head until 2003. I also became the first David Crombie Professor of Cultural Pluralism and Health, a position endowed in large part by the Canadian government’s Department of Multiculturalism. I was also appointed founding director of CERIS, the Toronto Joint Centre of Excellence for Research on Immigration and Settlement. Having concluded my term as director, I continue my affiliation with CERIS as a senior scientist at the Centre.
In 1999, I obtained funding for a study of the possible role of resettlement stress in helping to explain elevated risk of tuberculosis among immigrants and refugees in Canada. I hired Owens Wiwa, a refugee doctor from Nigeria as research director for the project. One day, he invited me to come back to Nigeria with him to attend what he described as a small family funeral for his brother. I felt honored to accept. Just before we left, I discovered that Owens’s brother was the famous Ken Saro-Wiwa, writer, politician and activist who had been unjustly hanged in 1995 because of his outspoken resistance to the collusion between international oil interests and a corrupt Nigerian government. When we got to Nigeria, we found out that the government, which had promised to return the body to the family, had reneged. The small family funeral became an international event, with 100,000 people gathering to express indignation and solidarity. My husband, Tim, subsequently wrote a biography about our friend that describes Owens’s heroic pursuit to recover the body and return it to the family village, a pursuit that eventually reached a successful denouement. It’s a wonderful book about love and personal heroism pitted against greed and corruption, called The Politics of Bones. The Globe and Mail, Canada’s national newspaper, named it one of the 100 best books for the year.
I’m very proud of Tim’s work. My first marriage didn’t turn out well, but it did produce three extraordinary sons, and, more recently, two adorable grandchildren. The second marriage, the best thing I’ve ever done, has produced twin boys. Another of the best things we’ve done was to buy a 600 year old house in southern France. We now go there twice a year with our two little boys to bask in the sun of Provence, eat great food, drink the wines and hang out with an ever-increasing circle of wonderful friends.
Another product of that initial sad trip back to Nigeria was the creation of a joint University of Port Harcourt Nigeria/University of Toronto centre to enhance health capacity in the Niger Delta region of the country. Working with our colleague at Port Harcourt, Professor Nimi Briggs, Owens Wiwa and I have received funding for two mental health oriented projects conducted out of the centre and there is now a major AIDS-related initiative as well.
In 2001, I had a unique experience. For the first, and only time in my career, a community approached me and asked me to study them. The Tamil community was concerned about what they perceived to be a high rate of suicide and of depression. They wanted to understand why, and they wanted data to help them. With funding from the Canadian Institutes of Health Research, we conducted an epidemiological survey of about 1600 Tamil adults living in Toronto. We plan to release the results to the community in the very near future and then to prepare reports for scientific journals.
Aside from the Nigeria and Tamil projects, my major current preoccupation is the New Canadian Children and Youth Study, a longitudinal investigation of the health, mental health and development of more than 4,000 immigrant and refugee children and their families from sixteen different ethnocultural groups living in six major cities across Canada. One of the sixteen communities is the Ethiopian community of Toronto. Taking advantage of a joint program involving the University of Toronto and Addis Ababa University, I initiated a study with three Ethiopian colleagues in which we are comparing the Ethiopian children in our Canadian sample with a matched sample of children in Addis Ababa. I’m lucky to have an extraordinary groups of colleagues working with me on the projects, including Bob Armstrong in Vancouver, Linda Ogilvie in Edmonton, Jacqueline Oxman-Martinez in Montreal, Feng Hou in Ottawa, and Anneke Rummens, Laura Simich, Haile Fenta, Priya Watson, Clare Pain and Hayley Hamilton in Toronto.
I continue to be interested in the interface between research and policy, but I believe firmly that the general public is and must be the final arbiter of the value of both. In what I hoped would be a contribution to informing public debate about immigration in Canada, I developed a 12 part radio series that was broadcast on public radio in Ontario and Alberta in 1999. Two years later, colleagues from the media world and I developed a curriculum about immigration, resettlement, identity and discrimination for elementary school children. Following that, we developed a similar curriculum for high school students. The Department of Citizenship and Immigration Canada distributed the curricula to all public schools in Canada, and then redistributed if after 9/11. I was honored to receive a Queen’s Golden Jubilee medal from the Senate of Canada for these educational materials, and even more honored to be awarded the Order of Canada in 2004.
Regina, Saskatchewan, where I spent my first 16 years has changed a lot. People tell me it’s a much better place now. Although I have changed too, I’m still interested in questions and ideas that formed during my early days in that place – questions about racial discrimination, personal identity, community and being an immigrant. I plan to continue to work on these issues while also looking forward to new surprises that I’m sure are on their way.