Bridging cultural gaps in psychiatry
Luke Kim well remembers the day the resident he was supervising presented a certain patient to him. A 55-year-old, poorly-educated immigrant woman from a rural agricultural area in South Korea reported vague gastrointestinal problems, fatigue and a lack of interest in life. Although the resident suspected she had major depression, the patient denied feeling sad or depressed or having any psychological problems.
Kim advised the resident to ask the woman about traditional Korean concepts of mental illness, specifically, feelings of repressed resentment and anger, and wha-byung, which has many overlapping symptoms with major depression and anxiety and is defined as a culture-bound syndrome.
When the resident returned to the patient, she immediately responded to his new line of questioning and became animated with emotion. She poured out her bitter feelings about being mistreated for years by her husband and in-laws. Based on this, the resident could more confidently develop a treatment plan for the patient.
“I find that when evaluating depression in the Korean elderly, results are more fruitful if one uses traditional folk concepts than asking directly if they feel sad or depressed,” said Kim, who served as a teacher and volunteer faculty member for 35 years with the UC Davis Department of Psychiatry and Behavioral Sciences.
“Culture makes such a big difference in mental health and illness.”
— Luke Kim
“If a health worker were to explain that such concepts are taught during medical training because the United States is a multicultural society, I am certain that Korean patients would respond more favorably.”
When Kim retired in 2006, he wondered how he could continue to help foster multicultural training in psychiatry. His solution: he and his wife, Grace, donated $250,000 to establish the Luke and Grace Kim Endowed Professorship in Cultural Psychiatry. The donation, supplemented by contributions from the psychiatry department and the School of Medicine, established the endowment. Recruitment for the position is currently under way.
A life of adaptation
Kim knows firsthand how difficult it is to adapt to a new culture, especially when one’s past was traumatic and family was left behind.
Born in what is now North Korea, Kim was interned during World War II at the age of 14 in a military factory manufacturing weapons for the Imperial Japanese Army, which ruled Korea until Japan’s surrender in 1945.
Soon after, Soviet troops moved into North Korea and helped establish a communist government. Along with his schoolmates, Kim demonstrated against the communist ideology and teaching in the middle school. Russian planes fired upon the demonstration, killing some two dozen of his fellow students and wounding scores more.
The Communists also began persecuting Christians, and Kim’s father was identified and targeted for arrest. The entire family narrowly escaped and fled to South Korea. They rebuilt their lives in Seoul, but their misfortune continued with the outbreak of the Korean War four years later. Kim’s mother was kidnapped by Communist agents in Seoul, which was occupied by the North Korean military. The family never heard from her again.
Kim and his family endured starvation, separation, homelessness and refugee camp life over the next three years.
Kim then joined the South Korean military. Following discharge, he graduated from Seoul National University, School of Medicine, in 1956. He then came to the United States, where he earned his doctorate in clinical psychology at the University of Arizona. He completed his psychiatric residency at Buffalo State Hospital in New York and Napa State Hospital in California.
Grace Kim, too, is no stranger to adapting to a new culture. She also escaped from North to South Korea when North Korea became Communist, then emigrated to the United States in 1961.
The Kims were married a year later. Grace earned degrees in education and counseling and taught at Davis Senior High School for 24 years. The Kims have two adult sons and four grandchildren.
Building a departmental focus on cultural concerns
During his career at UC Davis, Kim devoted his time and energy to promoting cultural psychiatry. About 18 years ago, Kim initiated a seminar on culture, ethnicity and mental illness for second-year psychiatric residents, which was the beginning of a training program on cultural psychiatry at UC Davis.
In 1999, the Diversity Advisory Committee was established in the Department of Psychiatry and Behavioral Sciences. UC Davis resident training in cultural psychiatry took off, expanding exponentially.
UC Davis Department of Psychiatry and Behavioral Sciences
The UC Davis Psychiatry and Behavioral Sciences Department has rapidly grown over the last several years, more than doubling the size of its faculty and staff to approximately 70 psychiatrists and psychologists and over 200 total employees.
The department's administrative offices, outpatient clinic, consultation service and education office are located at 2230 Stockton Boulevard, directly across from the UC Davis Medical Center.
The Department's forensic and research divisions are located down the street on the second floor of Ticon II located at 2516 Stockton Boulevard, across from the Shriners Hospital.
Finally, a number of department faculty are located at the Imaging Research Center in Sacramento and the Center for Neuroscience on the UC Davis campus.Click here to learn more
Today, the department has become a nationally-recognized training program and educational center in cultural psychiatry. In 2007, the Diversity Advisory Committee received the American College of Psychiatrists Award for Creativity in Psychiatric Education.
The work of the committee was recognized for developing an innovative, creative curriculum for medical students, residents and fellows. UC Davis psychiatry residents have been awarded American Psychiatric Association Minority Fellowships each of the past four years, reflecting national recognition of the department’s excellence in cultural psychiatry training.
“Culture makes such a big difference in mental health and illness,” says Kim.
He cites differences in value orientation between Asian and Western cultures: Westerners emphasize independence, self-reliance, and privacy, while Asians are more family and community-oriented, preferring interdependence.
Different clinical idioms also emerge, according to Kim. Westerners tend to have more psychologically-oriented feelings, such as sadness, loneliness and depression, in contrast to more somatically-oriented complaints among Asians such as headaches, fatigue and indigestion.
Teaching and research targeted
The Luke and Grace Kim Professorship supports teaching, research and public service within the department. The major goal is to foster academic excellence and innovative research in the field of cultural psychiatry.
The professorship will also support cultural competence training and education initiatives for medical students, residents and faculty.
The Kims like to see themselves as “action-oriented.”
“We believe that talking alone is not a solution,” he says. “More important are your actions and the results.”
The Kims’ generous contribution ensures their goals will be actively pursued for many years to come.