7 Days

Last Friday: Served as translator (English/Spanish) for patient complaint to administration meeting.  The person I was translating for spoke 2 sentences total…at the end of a 2 hour meeting.

Next, I went down to emergency department to speak to a pregnant woman who may be referred to our Maternal Addiction Treatment (MAT) Program. Me (at the bedside): “Hi, I know you’ve had a rough last few hours…I’m here to talk to you about treatment and a way to recovery.”  Patient: “Can you come back? I feel like shit and I have to go to the bathroom.”  I still did my behind the scenes thing….coordinating with the psychparmacologist, the other half of the MAT dyad to review the case, get the labs and meds she needs ordered, arranging for an inpatient bed, informing ER doc & psychiatrist of status, getting OB online.  If it wasn’t for my MAT partner who kept checking her chart and coordinating care with MD and nursing staff, I wouldn’t think of her again until Tuesday.  Once she got admitted to the unit, reports say she was irritable, uncooperative and refused OB monitoring.

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Status: Emotionally labored

When rules about how to feel and how to express feeling are set by management, when workers have weaker rights to courtesy than customers do, when deep and surface acting are forms of labor to be sold, and when private capacities for empathy and warmth are put to corporate uses, what happens to the way a person relates to her feelings or to her face? When worked-up warmth becomes an instrument of service work, what can a person learn about herself from her feelings? And when a worker abandons her work smile, what kind of tie remains between her smile and her self? – Arlie Hochschild

Consider the waitress that must smile and be upbeat with each customer.  How does she feel at the end of the day?  What emotional price has been exacted so she can earn her wages?

Emotional labor has been studied in a variety of fields since the term was first coined by Hochschild in 1983.   The emotional component of service work includes the need for workers to figure out the “emotion rules” in the workplace, to learn to how to regulate their emotions in order to follow the rules through “surface acting” and “deep acting.”  Surface acting is akin to plastering a smile on your face.  The toll of emotional labor and its role in worker burnout has been correlated with emotional dissonance.  Emotional dissonance occurs when the emotion rules of the workplace require us to go against our genuine feelings.

In social work, emotional dissonance frequently occurs when our values of social justice, integrity… dignity and worth of a person clash with our employing organization’s demands.  I practice social work because it reflects my heart.  I do the work I do because I believe in it.  I go above and beyond because I believe in helping people.  However, sometimes my efforts go against the bureaucracy of my organization.  Or I simply cannot do the “right thing” because people in power do not agree with me.  An example would be feeling pressured to discharge a patient you know is not ready for discharge…or who doesn’t have a stable place to go.  The emotional dissonance in social work goes beyond the bounds of an agency, however.  When the social infrastructure limits our ability to do the right thing, we feel stymied by gargantuan forces.

We are called to social justice, and yet social change on a macro level feels like an incredibly heavy burden sometimes.

Today I doubted myself.  I felt like my heart was too much into my work.  I wondered if I was wrong to feel so much and so deeply when vulnerability is equated with weakness.  In over 10 years of clinical practice I have never become callous.  I have left high paying jobs that required me to work without my heart.

Today may have been a tough day for my tender heart.  But I have more than heart.  I have strong hands and a nimble mind.  Together, all three allow me to do the emotional work I do.  I know the rules.  I also know how to break them.  Sometimes letting my emotions show is the greatest act of rebellion.  And despite the emotional demands of my work, I will not stop being me.

Putting Freud in His Place 

“THE STUDY OF PSYCHOLOGICAL TRAUMA has a curious history— one of episodic amnesia.”

Judith Herman (1992) makes this claim, noting the study of trauma is fostered by a supporting political movement. To study trauma is to take sides between the victim and the perpetrator, and ” The victim demands action, engagement, and remembering.”

Since the moment I read Freud’s psychosexual theory I thought he was a huge phony. But it wasn’t until I read Judith Herman’s “Trauma & Recovery: The aftermath of violence-from domestic abuse to political terror” that I became aware of why I hated Freud and his Oedipus Complex. Freud, following the work of Charcot in 1885, studied hysteria. By 1896 Freud published a seminal work linking hysteria to sexual trauma in childhood. A year later, however, Freud repudiated this link, developing instead an intricate theory attributing hysteria and other psychological problems to a child’s libidinous urges toward the parent of the opposite sex. 

To acknowledge sexual trauma as the cause of hysteria would be to acknowledge that sexual abuse of women and children was rampant. Freud decided to maintain the patriarchal status quo and develop instead a theory that promoted the continued subjugation of women and ignored the damaging effects of trauma on the psyche. The depths of the lies housed in Freud’s theories are so aligned with society’s need to keep silent about trauma that his theories are still discussed today. Today, however, I am conscious of the deceit and can create a new space for truth for me and my clients. 

The truth is that I too have participated in the crimes of omission. Regarding trauma, I have taken the side of the perpetrator in my clinical practice. I have perpetuated silence and forgetting instead of acting on behalf of my clients and engaging with them unearthing their trauma. My motives then were to protect the client from my own ineptitude. I did not know how to work with trauma. I also had not studied how to treat it. 

My clients may have suffered in my hands because of my lack of awareness. One of my clients suffered a horrible trauma at the age of 10. What happened to her at the hands of a neighbor was compounded by the invalidation and emotional abuse perpetrated by her parents. I asked her about trauma on her first day of therapy. Because I did not feel prepared to help her (I had to study more, learn more), we did not address the trauma directly until a year into her treatment. By then, I’d become a dialectical behavior therapy (DBT) clinician and I’d begun reading Bessel van der Kolk’s “The Body Keeps the Score.”

I worry now that I did her a disservice. That waiting as long as I did may have capitulated the invalidation she got from her parents. I know that by the time we were both ready to address the trauma head on, she was courageous and fierce. I’d like to think that I was also. She was fearless in writing the story of her trauma on a piece of paper we burned. Standing outside my facility with a borrowed lighter we burned the paper after she read each horrible word out loud. She credits that moment to her liberation. Her life still had the same ups and downs but after that day she felt she had crossed the abyss from victim to survivor. 

She has taught me, more than any book, that I can help my clients and now I am no longer silent. I speak to trauma, I say the words out loud. And hopefully, I help clear a space where others can speak and remember out loud. 

Confession: I have been blind to my white privilege

“The engaged voice must never be fixed and absolute but always changing, always evolving in dialogue with a world beyond itself.” (p. 11) -bell hooks, Teaching to Transgress: Education as the Practice of Freedom

Today in class we participated in an exercise on race, social class and structural determinants of privilege & discrimination. In the discussion afterward, I made a comment about how race was not as relevant as the intersectional paradigm in understanding social class.   My argument was the reality in America today is that people experience multiple and overlapping marginalizations on individual, social and institutional levels.  An intersectional perspective for analyzing complex social issues demands a broad, community-based approach.  I continued to stress the point that it is simpler to view populations as homogenous—the poor, the homeless, the mentally ill—but this is a simplistic approach that thwarts creativity to solving the problem.

As I spoke, I looked over at Sarah, my friend.  She was shaking her head. She said, “It’s all about race. It’s still about race.” I tilted up my chin, gave her an uncertain smile, “So it’s black versus white? I just can’t believe it’s that simple.” She looked at me square in the eye, “You mean to tell me that slavery wasn’t real?”
“Maybe it is about color,” I responded.  In Peru where I was born, it’s not black versus white. The dichotomy is European descent (white skin) versus Indio (yellow skin). However, the color dynamic is the same. In my family, I was the favorite because I had the lightest skin.  I remember being 4 and experiencing my blonde hair darkening as a fall from grace.
“I have to admit, Sarah, I did have a privileged status growing up because I was pale skinned.” Sarah fixed her gaze on me again, “You don’t have to tell me about skin color and privilege! I’ve been living in this skin my whole life…” She points at her arm and mouths, “Midnight.”

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meritocracy

mer·i·toc·ra·cy
merəˈtäkrəsē/
noun
  1. government or the holding of power by people selected on the basis of their ability.
  • a society governed by meritocracy. 

     plural noun: 

  • meritocracies: a ruling or influential class of educated or skilled people.  

While researching the concept of privilege, I came across the term “meritocracy.” More on privilege in my next post, but I’m attaching a link to a piece in The Economist that expands on the idea. Is it only ability, skill & hard work that determine our place in American society?