ATLANTIC INSTITUTE
CONVERSATIONS ON CONFIDENCE PODCAST SERIES

PODCAST 07 | BOON LEAD TEE

Music Thoughts in G by Cheyenne Mize.

BLTee: Because I am Chinese, you have to learn a lot of Chinese values, and one of these Chinese values is humility. If you go back into Chinese literature, you can see a lot of stories and emphasis on one being humble and modest, and always remember to learn from others… I guess I’m a bit shy in nature and a bit shy when I need to talk about myself, even about sometimes my research. But then I realised the importance of it, because it’s a way of very efficiently communicating yourself, so that people can also have the opportunity to learn more about you…

F Sweeney: Neurologist Boon Lead Tee, Atlantic Fellow for Equity in Brain Health.  Born in Malaysia, Boon Lead studied medicine in Taiwan and developed an interest in dementia.  

Welcome to our final CONVERSATION ON CONFIDENCE with clinical psychologist and neuroscientist Professor Ian Robertson from the Global Brain Health Institute in Dublin, and me, Fionnuala Sweeney.  Ian is the author of HOW CONFIDENCE WORKS: THE NEW SCIENCE OF SELF-BELIEF.  In this series, we speak to Fellows from the Global Atlantic community about the role of confidence (or lack of it) in their lives, both growing up, and in their work today as Atlantic Fellows advancing fairer, healthier, more inclusive societies.

I began by asking Boon Lead to tell us more about her work with people living with dementia.

BL Tee: When I was practising as a neurologist and mainly seeing dementia, I realised that it was quite difficult for us to diagnose dementia patients that had language problems, or more specifically, what we call primary progressive aphasia, mainly because the current criteria or understanding of how to diagnose them is based on English-speaking participants. So that’s when I gradually realised that the linguistic features of a language does matter and it does impact the symptomatology of how a disease would manifest. Part of my main research focus is studying how Chinese language speakers, when they develop aphasia or speech and language problems, how they would differ from English-speaking cases and how can we better tailor or develop tools to identify them, especially at an earlier stage.

F. Sweeney: So how did that lead you to where you are in UCSF at the moment?

BL Tee: One of the best places to study primary progressive aphasia or frontotemporal dementia is at UCSF. So I had this great opportunity also to learn about the Global Brain Health Institute programme at UCSF. So, I went in and applied for it and got into the programme. And it was an amazing journey. In addition to developing more understanding in dementia, it was also very inspiring journey where you can learn from all your colleagues and your Fellows from all around the world, from all kinds of different disciplines. I’ve been exposed to different healthcare settings, but this is even more refreshing kind of experience where you really learn about how dementia is being faced in so many different countries, and how different perspectives exist all around the world, and it’s a really amazing learning opportunity, because you can learn so much more from friends and colleagues in the programme.

F. Sweeney: There must have been cultural perspectives that were different to yours, and experiences that you had to learn about and navigate?

BL Tee: Definitely. I think just how dementia has been viewed or patient-doctors relationship is rather different in different countries and also the healthcare system is drastically different, the interactions between colleagues and your supervisors can be also very, very different. In US, it is common after a certain interaction that you can refer even to your boss in first-name basis. But then when I had the chance to travel back to Taiwan with my mentor, I think one of my mentors back in Taiwan heard that I referred to her in a first-name basis and he was totally shocked, and he cautioned me to be more polite. So I can see how cultural difference can play a role, even on daily interactions.

F. Sweeney: And how does that manifest itself in your work, for example in dealing with other colleagues?

BL Tee: Well, I think a lot. I think confidence is very different in the few Asian countries that I’ve been in versus in US. People are more vocal.  In Eastern countries, you express confidence as a more quiet manner, and there is also a different way of being courteous or polite. For instance, during a conversation, it’s always more polite to have the other party speak first. Although you might have an opinion of your own, you always say, “May I hear your thoughts first?”  When you ask a question, it is a bit more courteous to not automatically assume that this wasn’t being brought up in a talk. So you always say, “Maybe I’ve missed it, but do you mind commenting on X, S, X and Y?”  

I can’t say for all Western countries, but I guess in the US, I noticed that this is a sign that sometimes would be perceived as having lack of confidence. This is something that was a learning for me, that people project and express confidence in a very different way, and also they perceive it in a very different way.

I. Robertson: Boon Lead, very interesting what you say about confidence in different cultures. Tell me if this is correct. In very individualistic cultures like in Western Europe or America, particularly America, the individual is a kind of brand that has to sell itself, you have to really project yourself in the way you’ve been describing. Whereas the research suggests that this doesn’t always tally with people’s experience, that in East Asian countries, there’s more of a collective identity. So people have less of this, if you like, individual ego-driven motivation and more of a group or collective identity. And within that collective identity, the need for the individual to project their own individual attributes should really come second to projecting the values and the aspirations of the group as a whole. From your experience, is there something in that?

BL Tee: I actually think that is really related with how confidence is expressed in the different cultures. Apart from individualism versus collectivism, I think in some ways it’s also maybe reflected in the upbringing of both different cultures.  In some of the East Asian cultures, a lot of the teaching is based on more negative reinforcement techniques. And I can observe that here in the US, most families embrace more positive reinforcement techniques.  I think that helps build confidence in a very different manner. If you are easily being punished when you make errors versus when you are being rewarded when you do something right, I think in the Asian culture you are more cautious in making errors and taking less risk. And that’s why probably you are also less vocal when you express confidence. Whereas it’s vice versa in the US culture, I would say.

I. Robertson: Have you had to change, have you had to adapt the way you behave and the way you think because of these cultural differences?

BL Tee: If I think about the journey of my career, and whether there are phases where I have to adapt, there was one period when I was doing my internship or starting my residentship.  I think that is a period where I did change a bit how I project confidence. As an intern, you start to have to run CPR [courses/calls], and so when there’s someone that needs CPR, you really have to jump into the situation and assert a certain level of confidence for people to follow your orders.  And people might not be a team that you often work with, so you have to very fast establish the hierarchy as well as the confidence to lead a team. This is where I first understand that confidence is quite important when you need to gain the trust in a very short period of time, and you need to lead the team in a very efficient manner.

I. Robertson: What a fascinating example of CPR.  Have you been in an equivalent situation in East Asia, and would your approach or your behaviour in a similar emergency situation be different, do you think?

BL Tee: In East Asian culture, when you want to appear confident, you project in a more assertive manner, less soft-spoken.  But I think in US, in addition to that, you even have to actually go into more focusing on yourself a bit, and really tell people who you are and what you do. When I started the Fellowship, I was sometimes a bit intrigued, but also overwhelmed by the amount of self-introductions we had to do with everyone we meet. I think it’s needed, because we are meeting a lot of amazing people, and it’s a very good way to get to know people all around the world and the community. But I never in my career prior to that had to do self-introduction in that kind of frequency. Confidence, the way you project it, is very stoic, a bit more quiet and a bit less focusing on yourself in the Asian countries that I’ve been in. Here it’s more open and also projecting yourself kind of manner.

I. Robertson: One of the features of individualistic cultures is that because your brain is representing yourself in a more separated, distinct way – you’re embedded less in your relationships - it leads to a greater degree of vulnerability of the ego, if you like, and in some people, a degree of narcissism, which can sometimes be quite corrosive of teams. I’m just wondering what your experience of this is in the different cultures you have worked in: the greater levels of (a) anxiety that comes from you being, if you like, the sole practitioner, the individual trying to confidently sell your brand, but also the ego defensiveness that teams can really suffer because one or more people in the team is spending so much time trying to protect their egos from criticism or humiliation. Have you experienced that difference in teams between different cultures?

BL Tee: I’m still figuring things out a bit, but I do agree that when you are overconfident, you might be flawed in being less receptive to other people’s perspective, and you might be not able to see things in a more comprehensive manner. And I think in the long term, it might be damaging because you become less empathetic, less approachable, less good a listener, and you also lack the great opportunity to learn from others.

Because I am Chinese, you have to learn a lot of Chinese values, and one of these Chinese values is humility. If you go back into Chinese literature, you can see a lot of stories and emphasis on one being humble and modest, and always remember to learn from others.  So, when I first encountered the different way of expressing confidence and perceiving whether one is confident, I do wonder whether there’s a way to appear confident but also retain the humility that you always have something to learn, and that you always have to be modest and make sure that you are approachable to others.

At the moment, I think that for me confidence is believing yourself, and I feel like if you truly believe in yourself, you don’t need confirmation from others, so you don’t really need to be that vocal to others, and you can still exude confidence in a quiet manner but at the same time you also share what you do and project yourself to others when people have an interest in learning that from you. But not like on every occasion you have to sell yourself in some ways.

I was talking with one of our GBHI Fellows, and she was telling me that glass half full represents optimism in English.  It was a very interesting thing, because in Chinese culture, there’s this phrase when we describe people as “half bucket full” or “half bucket of water full”. It really means that one person is less knowledgeable, because they believe that if you are less knowledgeable, like half bucket of water, you tend to make more noise. And so it’s a bit like saying if you are less knowledgeable, you are a bit more boisterous.

I. Robertson: You splash about and make a lot of noise, but you don’t get things done!

BL Tee: Yes, exactly. That’s what it means.

F. Sweeney: Boon Lead, you bring up something very interesting about if you have the confidence, you can remain quiet and you don’t need to brand yourself and be loud. In terms of the Global North and the West, we tend to talk a lot about being heard.  I wonder can you remain quietly confident?

I. Robertson: It’s a really interesting question, because at least in Western society, the less privileged you are in various dimensions, the less confidence you’re likely to have, particularly in the presence of the more privileged. And in that kind of situation, the essential thing is to try and dig away at that psychological and brain disadvantage that comes from that stereotype or class or race or gender-based lack of confidence, which really saps people’s potential.

And so being heard for someone who’s really suffering from that privilege gap, in our culture at least, is a pretty fundamental need. But of course, like all of these things in confidence, it can go too far. It can become precious, it can become slightly narcissistic in people who maybe aren’t that underprivileged, but who start to defend and project their egos in a way that can be quite corrosive of a team or a group. I’d be fascinated to hear what Boon Lead has to say about it.

BL Tee: When it comes to being heard or projecting or branding yourself, I feel that a lot of my seniors that I worked with in Asia, when they are confident, when it comes to a conversation, they seem to be more interested in learning from others, rather than telling others what they do. It’s not that they would not do it - they of course would like to also share what they do when there’s an opportunity of it. But it’s more like “I will first hear what you do before I tell you what I do,” or that there will be more balance – maybe 50/50 - of trying to learn what others do before telling people what you do.  Because that’s how we are able to learn from each other and appreciate the good work that each party is doing.

It’s also maybe sometimes a manner of trying to nurture a certain level of confidence in others as well, especially of someone that may be a bit younger than you in a career, that you want to help establish themselves.  Because it is also true that if they feel more secure, in a more safe environment, they tend to be able to present themselves better.  So, by talking less about yourself and giving them the opportunity to talk, I think it’s also the way of silently supporting them, I guess.

I. Robertson: That’s so interesting, Boon Lead, your observation that senior people in your culture are as interested at least in learning from others as they are about, if you like, selling their own wares.

Now, there’s another dimension to this, which is hierarchy and authority. I was interested you saying about how your mentor in Taiwan was a little bit surprised to see you calling your mentor by her first name rather than Professor. There are more hierarchical cultures where having a senior position leads to a greater restriction on the range of behaviours that more junior people are expected to show than would be the case in a more individualistic culture like in the USA.

I’m just wondering what your experience of hierarchy is?  We in the West and even within the West, even within Europe, there are certain countries where we’re surprised to see how apparently inhibited junior members of teams are in the presence of the senior professor, which is very, very different from the Anglo-Saxon model where there’s a much more, at least superficially, egalitarian structure, where you can call your professor by their first name et cetera.

I haven’t got my mind round these two observations of yours – the fact that there’s this humility value in East Asian culture that means the leader is anxious not to oversell themselves and to learn from others, versus the hierarchy and the power that goes with that.  Any thoughts on that?

BL Tee: I think there’s two aspects to it. So, if you live in a society that values collectivism much more, in order to function and move forward together as a team or group, you have to establish hierarchy I guess in some ways.  When hierarchy or the order of command is very fixed, it’s easier to move forward as a group, and so I think that plays a role in why most cultures that embrace collectivism can also generally have more a hierarchical structure in their social interactions.

When I was thinking about the humility and nurturing confidence for your more junior people, because it’s so hierarchical, if you do not give them the opportunity to speak, they would not speak. So, it’s even more important that you help them create an environment where they feel comfortable in sharing, or that you make sure that they get the opportunity to present themselves. Because unlike in US culture, most of the junior people I work with in Asia, if you don’t give them that opportunity, they might just remain quiet, and just listen rather than speak at all.

I. Robertson: An economist colleague of mine, Roberta Dessi, has looked at the role of confidence in collectivist and individualistic cultures. And she’s found that individual confidence, which is the belief that you can do something and it’s the tendency to slightly overestimate your own abilities, that countries where there’s more socioeconomic change, the more that people perceive there to be economic change, that there’s unpredictability in the future, the more they tend to show this individual confidence measured by a certain overestimation of your own abilities.

And that’s true within China as well, for instance, studies done within China, that the more people perceive the world to be not as predictable as others, the more they tend to overestimate their abilities. It’s almost like an adjustment to dealing with an unpredictable environment, is the need to develop your own resources and your own brand, if you like, for survival. Even outside of Asia in countries like, say Switzerland, where there’s higher levels of perceived stability compared to, say, the United Kingdom, you get paradoxically lower levels of self-esteem and associated self-confidence than in the UK and in the US, where there’s much more perceived changeability.

Does that ring any bells with you?  Have you found an a changing world or a change in cultures, that there is this adaptive function of developing your own individual ego more, and therefore the confidence that has to go with that?

BL Tee: I do perceive that there is a rise in individualism in some of the Asian countries that I have the privilege of studying or living in. And when I moved to US, I realised that it is also important to brand yourself in some ways.

I guess I’m a bit shy in nature and a bit shy when I need to talk about myself, even about sometimes my research. But then I realised the importance of it, because it’s a way of very efficiently communicating yourself, so that people can also have the opportunity to learn more about you. So, I think there’s definitely a change in it, and I just feel in the journey of finding the right balance to it, where I can be more comfortable with it, making sure that I don’t in some way be perceived as lacking confidence. But at the same time making sure that even when you do try to appear confident, you always must be reminded that you need to learn from others and making sure that you provide yourself the opportunity to learn from others.

I. Robertson: You have to keep your values to mind, and particularly the value of humility to try and keep yourself in check while you’re engaging in this – I suppose some people do that more than others.

I just have one more question for you, Boon Lead, about being a woman and the role of confidence.  Do you see that playing a role in different cultures?  Certainly, in Western culture, women on average report more challenges vis-à-vis men and particularly when things are not certain, particularly when they don’t have all their ducks in a row, as men are more likely to wing it and say, “I’ll do it” on average. There are many exceptions. Does that male/female thing play out in East Asian cultures do you think, as much as in individualistic Western cultures?

BL Tee: I do think it exists in both cultures. There’s definitely gender differences here as to how comfortable you are or the way you express confidence, I would say.  Men tend to be riskier or more vocal and I can see women being more reserved.  I’m not sure whether it’s because of the stereotypic impression provided when we are young that led to this phenomenon, or that in nature, woman tends to be more empathetic.  But I would say in both cultures, I do observe that, and I don’t think they are drastically different.

F. Sweeney: I’ve been listening to this with great interest.  We’ve focused a lot on your work, Boon Lead, and confidence in your work and speaking up and branding.  I wonder as a woman from Asia coming to the United States, beyond your work, were there any challenges to your confidence as one might expect settling into a new country, a different culture, perhaps more white people than you would have seen back home?

BL Tee: I view it as an adventure sometimes, because there’s a lot of things that you find far from your expectation and then you have to adjust to it.  When I was back in Taiwan, a doctor is held in high regard in the society, so in some ways me being a doctor would be a stronger first impression than me being a female.  I didn’t realise that when I was there, but when I’m here and then I look back, I realise that was the case.  I was being slightly protected in terms of gender differences, me being a doctor helped protect me from any discrimination that might exist between being a male and female in Taiwan.

And when I’m here, I guess I’m relatively considered soft-spoken. I think it doesn’t fit well with the stereotypic impression of being a leader.  So, I think in the professional setting, sometimes I do try to become a bit more assertive.  You have to slightly adjust how you speak or how you project yourself, just so that people feel that they are being led by someone that they feel comfortable with, or that you fit well into the role of what they commonly perceive as being a leader.  We are still not at the time I think where we can embrace different kinds of leadership. Subconsciously I think we still think of leaders being likely male, very vocal and assertive.  From GBHI experience, we know that leadership can exist in all different kinds. And I hope one day that we can be there to exemplify that, but I think on a day-to-day basis, there is some instances where you just have to adjust to it so that people can feel much more confident in you.

F. Sweeney: What you describe is, when you find yourself in a challenging situation, it seems that you adapt to it, you rise to the challenge, so to speak.  You’re not a passive recipient of the situation you might find yourself in, in adapting to a different culture or a different environment.

BL Tee: Well, this is not to downplay there’s no struggles or there’s no moment where you feel defeated, because there are times where, when you are not the stereotypic leader that they see, you might encounter more hiccups or more hurdles just to go from A to B. People can go straight to it, whereas you might have three roadblocks before you can reach your destination. So, it’s not to say that it’s not at times a bit defeating or frustrating.  I’m also I guess a bit more pragmatic or practical. I think you can’t change everyone around you, so you have to sometimes accept that you also have to change yourself a bit so that things move forward in a more practical manner.

I also believe that when you are in a position where you have a certain level of security or influence, it’s always important to reflect what has been difficult for you in your past and making sure that it’s not difficult for anyone that is more junior than you, that you build an environment where they don’t have to go through the same roadblock again.  So, it is always in my mind that, while I’m trying to adjust myself to a new environment, if one day I’m in a position where I can make sure that people identify or can see leadership in a different way, that I can also make sure that I grab the opportunity and try to exemplify that.

F. Sweeney: I think what you’re describing is you do have your challenges, but you don’t let them either through your personality, your character or your background, let them get on top of you. You think a way through them.

BL Tee: Yes.  It’s also believing that I can one day also bring changes and make it better for other people.  At least, that’s what I hope that I can do.  I also believe that hopefully I have the ability to do it if I have the opportunity.

Music Thoughts in G by Cheyenne Mize.

F Sweeney: Boon Lead Tee, neurologist and Atlantic Fellow for Equity in Brain Health, bringing us to the end of today’s CONVERSATION and to the end of this series.  

For more CONVERSATIONS ON CONFIDENCE, go to our website at www.atlanticfellows.org.  Here you can also learn more about the seven Atlantic Fellows programs empowering emerging leaders to advance fairer, healthier, more inclusive societies.  

I’m Fionnuala Sweeney. We hope you have enjoyed listening.  

ENDS | DURATION: 25’ 57

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