Susan
Welcome to Who We Are Inside, a Cupid Podcast. I'm so glad you're here. Welcome to Who We Are Inside, a Cupid Podcast. Today, we have Dr. Liz Miller, who is a professor of pediatrics, public health, and clinical and translational science, and holds the Edmund R. McCluskey Chair in Pediatric Medical Education at the University of Pittsburgh School of Medicine. She serves as the academic co-director of community partners for the Clinical and Translational Science Institute. She is trained in internal medicine, pediatrics, and medical anthropology, has over 20 years of practice and community-partnered research experience in addressing interpersonal violence prevention among adolescents and young and has diverse funding from many different government and national institutes. She has developed and tested clinical and community-based interventions in collaboration with youth, patients, healthcare providers, victim service advocates, public health administrators, educators, and school administrators. Dr. Miller, thank you so much for being here today.

Liz
Thank you so much for having me. This is such an honor, such a privilege to have the gift of your time today. Thank you.

Adriana
I want to start talking a little bit about your work, but you can feel free to put your personal experience as well. So tell us a little bit about the Pittsburgh study, because it really excites me and it's something that I'm sure our listeners want to learn more about it.

Liz
So thank you for asking about the Pittsburgh study, because telling the story about how it came to be and all just brings me an immense amount of joy. And I think that's so in our work is paying attention to what brings us joy. So by way of a little bit of background, I have had the privilege of doing community-partnered research for most of my career. And we can talk a little bit later about how I ended up with a PhD in anthropology. It's a story, but we'll sort of fast forward to coming here to Pittsburgh in 2011 and being asked to help co-direct and then direct the community engagement core within the Clinical and Translational Science Institute. Having the opportunity here in Pittsburgh to really spread my wings in terms of pushing the boundaries on what it means to bring community members into our science to conduct research with community and not on community. So in 2018, my department chair, Dr. Terry Dermody, the department chair of pediatrics, was really interested in doing some kind of impactful study around what helps children thrive. And at the time he envisioned something like the National Children's Study, which some of our listeners may remember was the failed attempt to have a nationally representative longitudinal children's health study. And he noted, and which is quite true, that we have many births, about 13,000 a year in Allegheny County, and that very few families tend to move outside of Pittsburgh. And so we have the opportunity and certainly have a lot of history of highly successful longitudinal studies in Pittsburgh. And so he was pulling together a kind of launch event in June of 2018 and had an opportunity to present this idea of a longitudinal study. A number of community leaders who had already been part partnered, you know, with our team doing research were in attendance. And as they were listening to speaker after speaker about doing longitudinal observational studies, one of them leaned over and says, you know, we've been surveyed and surveyed and surveyed, and we've not seen any impact from that. Another community member leaned in saying, this is feeling an awful lot like white scientists going after black baby DNA. And those really, really critically important comments, I was able to bring back to Dr. Dermody. And he's like, well, that's not what we want to do. Let's be much more mindful about bringing a health equity lens into this work. At which point he's like, but I don't do community partnered work. He's an infectious disease doctor. And he said, Liz Miller, would you be willing to take this on? And I said, I'd be willing to take it on, but only if one of the co-leads could be a community member. And I reached out to my friend and colleague Val Chavis, who at the time was the director of one of our family support centers in East Hills. She had already been an amazing educator for medical students, social work students, nursing students, with whom I was working, really helping them learn about the impact of racism on health and healthcare. And so I asked Val if she would be willing to be the co-director of the Pittsburgh study. And she accepted. And it took a great deal of courage, I think, to lean into this work and to actually challenge the ways in which we do our science. And one of the very first things that Val did is the only black woman in a room full white scientists leans in, looks around the room and says, what exactly do you all mean by thriving? Because what thriving for me and what it means for my neighbors is probably really different from what it means to you all. And that was when we started a series of listening sessions across Allegheny County using concept mapping, which is a wonderful qualitative research method, to gather lots of ideas about what thriving might look like as defined by community members, including young people. And Val also really leaned into community partnered research. Like this was the way in which we could move this work forward. And the way in which we structured the Pittsburgh study was for every scientific committee to have at least one community leader and a professional scientist working shoulder to shoulder and greater than 50 percent community member representation on every scientific committee. And as the work evolved, we had five developmental cohorts from pregnancy all the way to adolescence, as well as some cross cutting collaboratives that included data accessibility, environmental justice, health services, delivery and policy in place. And so the Pittsburgh study had its first real sort of community partnered retreat in November of 2018. And it was there that we actually created our 10 shared principles around honesty and transparency and communication about sharing data always back to participants and communities, thinking about transdisciplinary work, really committing for the long haul and working to build trust over time. And so it has truly been one of the most beautiful journeys. We somehow managed to navigate the pandemic and really pivoted at that time to being as responsive as we could be with our community partners to COVID, to increasing diversity in the vaccine trials, to equitable vaccine distribution. And so it has been an amazing, amazing process. And I think we're right at a point now where we've demonstrated proof of concept. We have gone from about $8 million over the last six years in catalyst funding from very generous donors, including Children's Hospital of Pittsburgh Foundation, the Grable Foundation, the Shear Family Foundation, PNC, and the Shear Family. And it is that catalyst funding has now turned into over $26 million in extramural research funding. So I think we've demonstrated that we can make community partnered research work. The challenge now is actually knitting it all together to have even more collective impact, right? How do you actually get each of us out of our narrowly focused research projects, right? Whether it's interpersonal violence prevention, which is my area, or oral health, right? All of these areas, right? And how do we actually say, well, to do violence prevention also requires being really mindful about the whole child, including their oral health, right? So how do we actually move a conversation where we're all focused on child thriving as our North Star?

Adriana
Liz, when you started talking about your work, you're so passionate about it. You said a word that really resonates with me, joy. So why do you think working with communities on a personal level brings you so much joy?

Liz
I really, really love this question, right? About bringing joy and being so mindful about joy practices in our work. And I will share with you, talking about the extraordinary Val Chavis, who co-founded the Pittsburgh Study with me. She got so excited about our work together that she ended up joining the Department of Psychology as their community engagement coordinator and became a Pitt employee. At the point that she became a Pitt employee, we were like, okay, but we're supposed to have a community co-lead. So what are we going to do? And this absolutely incredible anti-racist integrative yoga instructor, Felicia Savage-Friedman, had worked with me at our detention facility here in the county, providing yoga mindfulness and opportunity for racial justice-focused discussions with our young people who were incarcerated. And I was like, Felicia, do you think maybe you want to do this with me and do this with us at this point? It was like Pittsburgh Study is 240 plus community members large, right? And so Felicia has totally leaned into this work and with it has brought an absolutely incredible, deep, reflective, healing justice-focused lens to our work. And she has offered just ongoing anti-racism trainings for us, reminding us about our common humanity, digging deeply to find the courage to share about what drives us, right? And what's so interesting is that in my research training, being able to talk about joy, right, is just somehow not objective enough, right? And that we don't talk about our passion, our motivation. And in fact, when I started my interpersonal violence prevention research now 25 years ago, I had a research mentor who said to me, you will never get that work funded. You should do childhood obesity research instead. And really tried to squash the passion. And I'm just incredibly grateful that I was resilient enough and was able to find other mentors who were like, yeah, no, you can do this work and that you can actually dig into and pull on your lived experience to help with that as well. And so what Felicia has taught me is about the importance of scientists making themselves vulnerable, right? That we need to be at a place where we can talk about what's hard in the work, what drives us, our histories, but also to be constantly reflecting on how our work has impact, how certainly it has impact with the community partners with whom we work, but also how this work impacts us. And I think I find so much joy in the work because I've been encouraged to think about strengths, beauty, assets, right? And in my own healing have been really mindful about getting to a place where I can really say the trauma I've experienced doesn't define me. And in the same way, bringing a healing justice framework into everything we do is also underscoring for many community members, including the young people I take care of, is that the traumas that they've experienced are absolutely real, they're unfair, they're unjust, and those traumas do not define them. So I find when I think about what is it that brings me joy, there's this term that's called vicarious resilience, right? We talk a lot about secondary trauma, we talk about vicarious trauma, but what I have really come to recognize that brings me joy in the work is always paying attention to the resilience at the individual level, at the community level, seeing family connections, seeing love, and I really thrive both clinically as well as in my research on that vicarious resilience.

Susan
I love that term, vicarious resilience. I'm going to remember that. I'm hoping that you can say a little bit more about your lived experience and how that really kind of brought you into this work or brings that joy and I think personal drive, I would imagine, into this work.

Liz
Yeah, thank you for that question, because as I was alluding to, I think certainly as an emerging scholar many years ago, I was really dissuaded from talking about my own lived experiences and very much like, oh, you know, don't tell people that you're a survivor and, you know, just do your violence prevention work with great objectivity. And for years, right, I've, you know, really kind of hid the fact, right, that I'm a survivor. And there have been just amazing mentors, teachers I've had along the way, you know, all people who've experienced many, many layers of marginalization and oppression who have really encouraged me to rethink that and to say it's so vitally important, especially those of us with power and privilege, to share about our histories and what drives us and to model making ourselves vulnerable in the process. I think part of my hesitation has been that I don't want people's sympathy, right, and I think that makes it hard. You know, I identify as a, you know, white passing, you know, cisgender Japanese Jew. And, you know, it's like my own sort of upbringing as a, you know, the daughter of a Japanese woman and a Caucasian man from Gulfport, Mississippi, which is a, it's a lovely story in and of itself, but a complicated one, complicated in that my father, his ancestors were all white supremacists. And he left Gulfport, Mississippi as soon as he could. But that history, right, was always there. And we never really had a chance to explore that together until he was dying. And he used to, he felt so guilty about having left Gulfport that he would airdrop me to spend the summer with my grandparents and cousins and, you know, aunt and uncle every summer from the time I was about eight till I was 12. And he literally would drive me up to, you know, my grandparents' home and say, I'll see you at the end of the summer. And, and, you know, it was there that, you know, I was experiencing racism, but not understanding what it was, you know, experiencing sexual abuse and not being able to even talk about it was when I tried to share with my grandmother, was told to, you know, forgive and forget. And, you know, and then you carry those kinds of childhood traumas with you into adolescence. So no surprise, right? I had, you know, more experiences of sexual abuse in, throughout high school and, you know, dating violence and date rape experiences as well. So, you know, like, you know, people, I'm sure our listeners are familiar with the adverse childhood experiences score, right? And I'm like, yeah, my score is actually pretty high. Because, you know, my dad was, you know, also struggling with his own traumas. And so I grew up with an alcoholic and, you know, with violence in the home as well. So, you know, I'm like, yeah, I have a pretty high ACEs score and that doesn't define who I am. And it absolutely drives, right, the kind of work that I do. Totally drove me to pursue my PhD research on the trafficking of adolescent girls from Southeast Asia into Japan's sex industry. I then, you know, became really focused on the ways in which we erase gender-based violence and continue to do so, so often and became really quite an advocate for intimate partner violence and sexual violence response in the healthcare delivery system. And so that, you know, certainly my own lived experience is absolutely, you know, at the core. What I had not appreciated for many years, but now as a more senior scientist is that many, many people who are drawn to violence prevention work, social justice related work have a lot of history as well. And on my team, we have many, many survivors. And I think just for me, how much I have really shifted in wanting to uplift my team, make sure that our space feels healthy and safe and supportive and that we bring a survivor-centered lens to everything that we do. And I know that I'm woefully imperfect and have plenty of blind spots. And I hope that I'm creating a workplace environment for us to the violence prevention work whilst simultaneously taking care of ourselves.

Susan
Thank you so much for that and for sharing your story with us. I'm wondering, there's so much that your and your colleagues' lived experience can bring to this work. What's kind of one or two things that you feel like really make a difference of having that lived experience, both in your clinical work and in your research?

Liz
So I think lived experience is so important to tap into because storytelling and how we tell stories is so vitally important for providing context, but also for, I think, guiding the kinds of questions that we ask. And if we're not really listening to each other, both recognizing similarities in stories and the threads that run through so many stories, but also what makes us unique and how do we make sure that everybody feels like they belong and that they're cherished is so important, whether it's in the clinical space or in the research space. And we just actually did this beautiful activity on our research team asking everybody to think about their passion projects. Like what are things that you're passionate about? And then we've now been really thinking about how do we integrate those passions into the work that we do, the kinds of research grants that we look for, the projects that we embark on? How do we better connect with each other across our passions? It's been so much fun. And I think allowing people to bring their whole selves as much as they want into the workspace.

Susan
You do community-based research that involves communities for which you share identities and communities in which you don't. And I'm imagining you're wearing these two hats simultaneously of being a part of that community that is being studied, and then also the researcher who is doing the studying. How do you navigate that or where's the sticky parts in that?

Liz
Oh, it's such a neat, that is such a neat question because isn't that what we're always doing all the time is navigating our different identities in different spaces, right? And I think part of the anthropological training just I think probably made me reflect on it in a way that from a social theory kind of space and recognizing that it's not so cut and dry, right? That you're the researcher and then there are people that are being researched, right? But that there is a lot of overlap and that we actually bring a lot of our subjectivity into the work. And at the same time, I'm acutely aware in particular working with our Black neighbors here in Pittsburgh of what an immense privilege it is for them allowing me, right, to be in partnership, to be in relationship with them as we do our work together. So one of the things is, you know, I really start from a place of I just don't want to make any assumptions that people even want me in this space and that there is also you know, even though, you know, I could argue, I grew up in Japan, I don't really, I haven't participated in racism in the US and so on and so forth, right? That no matter what room I walk into, I have the University of Pittsburgh on one shoulder, UPMC on the other shoulder, and all of my personal history of navigating the world in the United States as a white passing Japanese Jew, right? And with that comes like the recognition that wherever I go, I have to be in that place of repairing, repairing the things that others have done. And it's easy to say, oh, it's not my problem, but our university, our healthcare delivery system have done so much harm over the years that it feels to me as a senior scientist, right? That I have to be in that place of continuously working on repair and not assuming that, you know, I get a pass because, you know, I'm a little bit of a foreigner here.

Susan
I love that word repair. It's one that I think about a lot as a parent, you know, when you behave the way you don't want to and you have to repair. And I think it also, it comes from that place of gratitude, right? That I'm so grateful to be here in this space with you, and I'm gonna demonstrate that gratitude by working on this repair, even though one could argue that I am not a source of the problem, and yet my presence in and of itself is a source of the problem. That's really beautiful. When you started sharing your story, you mentioned that you were a little hesitant to share because you didn't want sympathy. So thinking about our listeners, because all the topics that we talk here in this podcast, they are hard topics to talk about. So let's suppose I'm in a situation, I know you, you're my friend. However, what if somebody that I don't know very well wants to share something with me? So putting myself in their shoes, what is the best way to respond? Listening and what else can I do to make that person feel safe and trust me?

Liz
It's such an interesting question around how do we create space for disclosures to happen? And how do we respond to those disclosures? And for a while, I used to think that I had a tattoo on my forehead that said, disclose to me. Like every time I'd get on an airplane, I would be like, maybe I better put my ear pods in, right? Because it just, you know, there's like something, right? I think about the way in which I engage with people where they're like, oh, this person looks like a good listener, right? Which I am. And I have to say, I love listening to people's stories. And it's probably the anthropologist in me or why I was drawn to anthropology. I love, love, love people's stories. Like every Uber that I get into, right? I'm like, tell me more. And so there is probably, you know, that we share that tendency, right? Of people seeing that we're good listeners. And I think, you know, what's so interesting is over the years of interviewing survivors about what they want. Some of this work actually done by one of our dear colleagues here in Pittsburgh, Dr. Judy Chang at McGee. She was one of the first researchers in the intimate partner violence world to interview survivors about what they wanted health professionals to say, to do. This is in the early 2000s. And it was at a time when we were thinking that screening for trauma, screening for domestic violence was the way to go, right? And so we spent a lot of time like, what's the right question that we want the clinician to ask, right? Are you in an abusive relationship? Are you experiencing domestic violence? Do you feel safe at home? Are you afraid, right? All of these, like, what's the right question? And nobody had ever bothered to actually ask survivors whether that was how they wanted to be approached. And what Dr. Chang found in her research was survivors asked for four things. One, stop being so judgmental. Second, please listen. The third was please offer information and resources regardless of whether I choose to disclose to you. And number four, please don't force me to disclose. And for me, that research was an absolute paradigmatic shift in terms of thinking about work and thinking about how much courage it takes for somebody to share their story with us. And I think has put me in a place where whenever one of my patients shares their story with me I hold it like a glass ball. I'm just like, thank you for sharing that with me because it takes so much courage and I wanna handle that story with the preciousness that it deserves. The other thing though that I've now started doing in my clinical practice is saying to every young person, what we talk about in here stays in here except for, right? And then I do my limits of confidentiality discussion because I take care of mostly minors. But I also say to them, you are under no obligation to share your story with me. There's absolutely no reason that you should trust me and that's for me to do. Like I need to gain your trust and giving them the out to not have to share. And I'm like, I'm gonna give you the services, supports that you need regardless, right? Of what you choose to share with me. What is so interesting and getting back to your question about how do you respond, right? Is what I've found over and over again is young people leaning in saying, you feel like, like, I feel like you're the first adult who's ever bothered to listen to me, right? And so there is the not making an assumption that people have to tell you certain things, giving people permission to have control over their stories is just extraordinarily important. Whether it's doing interpersonal violence research or in my clinical practice. And I will share with you just last week, I was sitting with a young person who's incarcerated. I always start my visits with strengths. And one of my questions is, tell me what brings you joy? And this young person was like, nothing, I'm here, nothing. And then we're kind of going through the history and it's like getting ready for his physical exam. And he looks up and he goes, you know what brings me joy, talking to you. And I was like, I love you, that is just so good, right? It was so affirming. And, but also, just that incredible opportunity, right? That we have to be able to, whether it's in our research or in our clinical practice to see each other's common humanity. And I think treating people's stories with the respect and gentleness that that deserves, I think is one piece of that puzzle. Yeah.

Susan
Oh, I love that story. That is just like, I think every clinical provider's dream. Who has joy seeing their medical provider? That's awesome. I, I'm wondering, I'm wondering if you could maybe share like what, maybe a few things that people get wrong often in engaging with young people in general, or, you know, particularly survivors.

Liz
So I think we trip a lot. So there's sort of big picture things, which is, and in particular with young people experiencing marginalization and oppression. So the, you know, the young people I have the privilege of serving here in Pittsburgh are primarily court system involved, child welfare system involved. They're on, you know, unstably housed, unhoused. And it is really easy, I think for us, especially as clinicians who are trained to, like you need to fix things, right? To want to lean in, to try to fix it and fix the situation. And quite a bit of that white savior, you know, approach. That, you know, and I, to going back to what I was saying earlier around intimate partner violence, you know, sexual violence and trauma screening, right? That is so grounded in that white savior mentality, right? I'm going to like ask the question and then this person's going to tell me and then I'm going to save them, right? And, you know, certainly in the old days, I mean, like, you know, it was like, if somebody did disclose domestic violence, we're like, oh good, the solution is to go to shelter, right? As if like 99% of people are not interested in that as an option, right? And so there is this, the ways in which we get it wrong is so much how we dig our heels in, in the healthcare system with us holding the power and the connection to resources. And unless our patients disclose to us, we don't connect them with that, right? And, you know, I think for me bringing much more of a healing centered lens to my clinical work and my research has been totally flipping that on its head saying, you don't actually have to tell me your story. And I take care of so many young people who've experienced all kinds of complexity. And so I'm offering this information to every young person I take care of. And that not only am I offering this information to you, I suspect you know somebody who could use this information. So I want you to take it along with you so you can help somebody else. And you can imagine a young person's eyes light up with that, right? Because they're like, I, you know, many of them are like, I know exactly who needs this, right? And so tapping into that just beautiful generosity and altruism that is, you know, young people, but you know, our adult patients as well, everybody wants to help. So there is a lot I think that we get wrong in the healthcare delivery system. I would argue that we are doing this right now in how we approach health-related social needs. Again, very much from a screening perspective, as opposed to, wow, many of our families are leading complicated lives. It's, you know, continues to be bumpy even since the pandemic. So here's information on food resources. You can feel free to take a bag of food with you if you'd like, right?

Susan
Why do we force people to have to disclose? I'm really glad you brought that up because I have a son with complex medical needs and sometimes we'll have like four appointments at Children's in one day. And I have to fill out that questionnaire four times. And you're just like, can't this just get uploaded to the EMR? Do I have to answer four times in a day? And you know, luckily for me, I'm privileged. I, the answers are easy, but I can only imagine the burden that that puts on families who then feel obligated in some way to answer more than once in a single day and the courage and strength that that takes. Yeah, yeah, that really resonates. Thank you. Yeah, no, absolutely.

Liz
And, you know, given how many families worry about child welfare getting involved, right? That, you know, as a parent with, you know, three little ones, would you, you know, be willing to tell the pediatrician, I'm actually really worried about putting food on the table, right? In fact, actually just a few weeks ago, I was talking with a caregiver of a young person who's, you know, lots of complicated things going on. And the, this caregiver's response was, you know, food's, you know, food security and trying to do it in, you know, as thoughtful a way as possible. And she's like, don't you think that's overstepping, right? And absolutely from her perspective, right? It was delving into things like what, you know, she's like, don't you just do medical stuff, right? And we actually ended up having an amazing conversation about the ways in which systemic racism shows up in healthcare and the conversation turned out fine. But it was so revealing to me, right? That our patients and families may actually be perceiving all those screening questions as overstep and another way to shame and humiliate our patients.

Adriana
Yeah, yeah, absolutely. I have goosebumps every time I listen to you. It's just so amazing the work that you do. I wanna ask a question. We talked about joy and the other word that comes to my mind, and I think they go together sometimes, is gratitude. So what I feel when I work with unhoused folks is that they are so grateful and their gratitude makes me feel more joy. How do you feel when you are in this space?

Liz
You know, absolutely. You know, gratitude that just appreciation, right? That we get to do the work that we do, it's so amazing. And I think the other piece of this is being mindful that we don't expect the gratitude, right? And so, you know, having that young person look at me saying, talking to you is bringing me joy, right? Was like, okay, that, you know, I was like, pause right there, that is such a gift to me and I'm going to hold onto it and I'm going to tell everybody this story about how you made me so happy, right? And then this young person's like beaming because he's like giving me a gift, right? And so there's this like incredible sort of exchange, again, getting back to a recognition that we have this shared common humanity and desire to connect, right? And I think that's the gratitude piece is also that sort of intense human connection that comes right with our healing profession, you know, as well. So yeah, I certainly, you know, part of my joy practice is also every day kind of reflecting on things that I'm grateful for, right? And like today, it was like I was on a really extended, you know, Zoom call and I was able to text my spouse going, I'm never going to get off this Zoom call and I'm really hungry. And like five minutes later, there was like, you know, warm food, right, right there. And I'm like, oh, I'm so loved. I'm so grateful. This is like so good, right? But just being, one of the things that my mom was so good about was always reminding me to say thank you, thank you, thank you. My dad was always do the right thing. And so you've got, you know, on one shoulder, do the right thing and the other say thank you a lot. And it does, right? Both of those things really help bring joy as well. I just heard something this morning that made me think of that, which is that happiness is not a goal. Happiness is what we feel when we are pursuing our life's work.

Susan
That really, yes. You mentioned your joy practice and it makes me wonder a lot of your work, I imagine it has an emotional toll. How do you, what are your practices in order to balance that in yourself?

Liz
So, you know, one of the beautiful things about violence prevention research is over the last decade, there's been increasingly more interest in resilience, flourishing, wellbeing, and I think, you know, it's that kind of research literature, right? That I'm tapping into as we think about child thriving and racial equity in the context of the Pittsburgh study. So what we know about building resilience is that there needs to be sort of three critical ingredients. And I think this will resonate with the two of you. One is mindfulness and emotion regulation. It's the deep breathing. It's taking time to meditate, right? Learning muscle relaxation, grounding techniques. The second is connectedness, right? The importance of human connection, being in relationship with each other and really seeking out, right? Those connections. And then the third area is kind of purpose and meaning, right? What is my reason for being on this planet? And for me, it really, so much of that is tapping into my Jewish faith and this concept of tikkun olam, which is about repairing the world. And, you know, really as, you know, everyone's obligation and certainly obligation is Jews. And so it's those three buckets, right? That really contribute to my joy practice. I'm rather fanatical about exercising because I find that really incredibly grounding and helps me with my emotion regulation. I call it my Prozac, my daily Prozac, right? Is my exercise. And then connection is just being so mindful about saying thank you to folks, right? Reaching out to, you know, texting a dear friend, saying I just thought about you today, right? That, you know, those kinds of moments of just being like really intentional about like I am connected. And then again, just always really coming back to, you know, some of the rituals that are deeply meaningful to me as a Jew. And, you know, I think so those three strands I also actually bring into my clinical practice and talk to young people about like these are three areas that I really want us to work on, right? Because it really builds your muscle in the context of some really unfair and unjust things happening in your life.

Susan
I'm sorry, I have to ask another question. I'm thinking about connectedness. I'm thinking about a generation that has, if not grown up with a smartphone, grown up around smartphones, or, you know, some of your patients who are incarcerated where connectedness is there's inherent barriers there. How do you do connectedness? How do you work on connectedness? I think that is like a million dollar, multimillion dollar question.

Liz
It is, right? And it is actually so interesting because it's one of the questions, right? In the Pittsburgh study, which is how do we do connectedness across disciplines? How do we do connectedness across systems, right? Our systems are so frigging broken, right? And, you know, nobody's talking to anybody. We're duplicating all kinds of effort, you know? And in the meantime, you know, kids are missing school. They're getting suspended, like all such things, right? And so connectedness is a systemic problem, but it's also an interpersonal problem. And one of the things that we know in the adolescent health literature is that having one adult in your life who is dependable, the person you go to when things are bumpy, right? Is one of the single most important protective factors for a young person. And so connectedness is so vital. And I think, you know, clinically, when I have a young person say to me, there isn't anybody, I'm always asking who's the safe adult, who's the person, right? And, you know, oftentimes they'll identify a parent. And, you know, I always make a point even when they're incarcerated with the young person's permission to reach out to that parent and just, you know, assure the parent and, you know, get a little more medical history, all of those things. And when I get on the phone, I'm like, I love this. You know, your child is amazing. And I want you to know how much their eyes lit up when they were talking about you. And because whatever I can do to strengthen that tie, I know is so much more important than any prescription I could ever write for that young person, right? And so one of the things that we do in violence prevention work is build mentorship programs, build more safe and supportive adults, you know, and find places, right, for young people to connect with other adults so that we can really shore up that connectedness. Because I think, you know, one of the things that was really eroded during the pandemic, right? You know, certainly when we were on lockdown, but how long it took for our public school districts to get back in person. Has meant that many young people went for two years, right? Without being able to exercise that sort of social support, communication, relationship building, all those muscles, right, really atrophied. And, you know, people talk about learning loss, but I'm like, we actually really lost on kind of the social network, right?

Susan
You'd mentioned that your story about getting into anthropology was interesting. And I don't know, have we touched on that yet?

Liz
So the story goes basically like this. So I went to, I moved from Japan to the US for undergrad. And my mom was, you know, very Japanese. And so it was Harvard or Bust, right? That's the only university that counts for anything in Japan, right? And so when I didn't get into Harvard for undergrad and got into Yale and Stanford, she's like, I don't care where you go. And I picked Yale because the guy I was dating in Japan at the times, dad and step-mom lived just outside New Haven. So I was like, I'll kind of know somebody. So like, let's like, I'll go to Yale. Never seen the campus, knew nothing, whatever, right? And it was even more, it was funnier because, you know, I got there and they were like, oh, you're. Asian American, you should join the Asian American student group and here's your Asian American mentor. And I'm like, what's Asian American? So it was a, well, you know, real, quite an interesting introduction to how we think about race and ethnicity in this country. It's bizarre. And, you know, again, underscoring, it's all socially constructed. And I totally didn't fit into to that because we just didn't share, you know, similar sort of history there. And on the Yale campus, like one of the first people I met was like, oh, you're from Japan. Do you speak Chinese? And I was like, oh, oh, I remember saying I'm one of the, you know, way back in the collect calls kind of day. And I remember calling my dad really quickly and I was like, I thought you said this was an Ivy League institution. What's going on? So, so all of that to say, as an undergrad, I actually studied art history, but did my pre-med classes and, but was really just continuing to sort of be fascinated with how people navigate across cultures and try to make sense of the categories in this, you know, in the United States and where and how we fit in or don't fit in. So I actually did my senior thesis on contemporary Chinese artists in New York. And again, very much from that place of like interviewing them, right, about their stories and how they were melding what they were learning in the modern art world in New York. And all of them, you know, traditionally trained, you know, Chinese artists. And so I go to med school. My mom was very pleased. I got into Harvard for medical school.

Susan
Congratulations.

Liz
Thank you. And my parents had, you know, I was very, very fortunate. They're both English teachers and had helped pay for undergrad. And so when I got into medical school, they were like, good luck with that. So I was on all, you know, a hundred percent loans. And and so between first and second year, I wrote a little grant to do summer research back home in Japan and at the time was working with Boston's Health Care for the Homeless program. And so I was like, I'll study health care for the homeless in Japan and went back and had an just absolutely amazing summer working with a Japanese Catholic organization and a bunch of Japanese communists and from them learning street medicine and the support they were providing for day laborers and migrant workers. And my faculty advisor for that summer was a medical anthropologist. And I'm like, what is this medical anthropology thing? And started reading about culture, the difference between disease and illness, right. People's experiences of illness and the importance of storytelling and ethnography. So I was totally smitten with this whole field. I returned in my second year of medical school and they're like, Liz, you seem interested in these social issues in medicine. We have a grant to pay for a student to do an MD PhD in the social sciences and we'll pay for the rest of medical school and all of graduate school. And I'm like, yeah, can you sign me up? And so I end up with a PhD in anthropology completely, you know, based on like, sure, I'll do that. And it ended up being absolutely incredible. I mean, both, you know, I got to meet my spouse in first first year, you know, graduate seminar. But also it was where I was exposed to critical social theory, right, and black feminist scholarship. And I'm like, oh, my gosh, like mind blown. Right. And I think that experience, which, you know, thank goodness for the grant funding. Thank goodness that, you know, I had a good chunk of my education covered. You know, I emerged with a lot of sensibility around how we use power and privilege in the work that we do. And so, you know, then leaning into community partnered research has always been from that anthropological lens.

Susan
That is a great, a great story.

Adriana
I can't say thank you enough for your presence here today. You were so inspiring.

Susan
You were my role model. You know, thank you.

Liz
Well, right back at both of you. Thank you. Thank you. Thank you for putting this podcast together. I love that you're encouraging and uplifting vulnerability as a way for us to be in the world and actually do the work of repair. Right. So, yeah, I appreciate you both so much. Thank you.

Susan
Thank you for being here. Who We Are Inside is created and hosted by Susan Graff and Adriana Modesto Gomez-Da Silva in collaboration with Karthik Hariharan and John Ganan. Thanks for being here.

Music
♪ I still have stories to tell ♪ ♪ I feel ♪ ♪ I still have stories to tell ♪