Monday, April 17, 2023

What Did You Do? Part Two

When I started working at the hospital, it was in an entry-level, not-very glamorous position, working directly with patients for eight hours straight, under the direction of others with little opportunity for independent thought. As these things go, however, there turned out to be ample opportunity for independent thought, as there was never enough staff and supervisors had to be in many places at once, so unit staff had to figure out constantly-changing situations on our own. 

People write excellent memoirs of starting out at such jobs all the time, of the various dysfunctional coworkers who were hard cases, or undisciplined and directionless, or simply not that bright, interspersed with a few who were of surprising Christian character and ultimately inspiring. The supervisors and powerful people were likewise abusive, stupid, and jaded, except for the few who taught them some Important Lesson which they have never forgotten. This was like that, yes. It was that sort of job, like being a waiter in a bad restaurant or low man in some construction of assembly position. 

I have always been of two minds, or more likely five or six minds, as to whether this was good for my character or destructive to it. I was not all that good at it.

It was already clear from school, and testing, and conversation that I had a much greater capacity for memory than other people, but if you had asked me how that helped in my current job it would have taken me a moment. We would have long strings of directions of what had to be accomplished for each patient every day and I would not have to keep going back and looking those up, nor would I need to enter the data quickly. It saved time. I was efficient. I was learning by curiosity about the various diagnoses and treatments, but also the specific patients and their legal or early histories and how those impacted treatment. It was important to know that some patients could not ever leave grounds or had some pending hearing that might be destabilising to them, or that others did not like to be approached in particular ways or by people with certain characteristics, because of trauma received at the hands of others years ago.  

I had a good working knowledge of what being triggered was long before we were using that term. The physically and sexually abused showed a spectrum of responses, from subtle to explosive. Marie has been upset all morning. "Oh, Maurice worked down here last night and he's black. She was raped by two black men as a girl and is still afraid of all of them." The vaudeville shtick of a Rave-Off, a phrase that sends someone over the edge like "Niagara Falls," has a real base to it. Such knowledge was like gold to unit staff, learning to avoid setting someone off. At the time, and indeed for years later, we took it for granted that these PTSD responses would be based off accurate information, because how could they not be?  The person was responding to A Memory, which we conceived as some kind of video clip in the brain that would get bumped into and activated on some screen of consciousness. It was not until I got to the neuropsych part of my career, well after the false memory and satanic ritual abuse scandals, that I learned that this was an imperfect and unreliable way of looking at traumatic memory.

I in fact chose Marie as my example above for that reason. She was discharged and readmitted a few times, and once came to my caseload fifteen years into my career, when she stayed long enough that I was expected to write a very comprehensive history of her life. We don't do that anymore, but at the time we were expected to go through all earlier charts, hundreds and hundreds of pages and write a paragraph about education, and religion, and siblings or a dozen other things, including sexual and trauma histories. There was mention of her being raped just before her first admission at age nine, but no identification of race of the perpetrators. In New Hampshire in 1948, it would have been mentioned if they were black. I thought it odd. Her mother was still alive and I took here aside when she visited. She remembered me working with Marie before. It turns out the attackers were not black, they were eventually revealed to be her cousins, who came at night and tried to cover their faces. But Marie was also developmentally delayed and had told herself they were black men, and responded badly to black men forever after. I eventually learned that one does not have to be DD to make that sort of error.  In fact, I have a personal opinion that very bright people might make more errors in traumatic memory.

But I am ahead of myself here. I was supposed to be talking about powers of memory and how they affected my job. I honestly was only great with certain categories of patient and lost my temper with others far too frequently. But I got along great with staff of all status. Those who looked down on psych techs took longer than those who resented the college-educated to warm up to me, but I was determined not to be excluded from anywhere since I was in elementary school, so I managed. The people who had never had educational opportunity but had picked up things along the way were my eventual favorites to work with. Just before I got a small promotion out of that type of work, one of them said "I enjoy watching how long it takes people to figure out you're smarter than they are." Fun to hear, but I always thought there were lots of people smarter than me, at least in some ways. But because I was easy to slot in I got moved around to trouble spots and learned the backgrounds of a very large percentage of the patients. That bank of knowledge was already becoming useful to me, and I was looking at "what is a good memory" in different ways.

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