by Robert Lanz, LCSW
“Think how to fit disparate things together.” – Jonah Berger, Marketing Professor, Wharton School of Business
I hate to be the guy who would stereotype anyone. That said, generally speaking, most gunshot victims are black or brown, and most of the guys that shot them were black or brown also. The occasional white guy or Asian guy who comes into the trauma center for being shot is most often shot by a black guy or a brown guy who was robbing them. Hey, don’t even start in on me about this, I’m only the messenger.
Anyway two young black guys came in as trauma codes because they had been shot in a neighborhood where black on black target practice was a frequent pastime. Many of those victims act as if having been shot is not that big of a deal and they remain passive or even hostile while in the ER. Either of these might be considered normal reactions in some areas where frequent shootings take place. But these two young black victims weren’t covered with tattoos. They were cooperating with the police and it was pretty obvious they were terrified. It was pretty obvious also that they hadn’t come from a neighborhood where this was normal behavior. And other than being African-American they most likely
had little in common with the guys who shot them. They were essentially middle-class white kids in black skin, and just like a terrified white kid who had been shot, were prime candidates for post-traumatic stress disorder or the shorter lasting Acute Stress Disorder. The common symptoms of these disorders generally occur after exposure to some extreme event likely to cause death or serious injury and for some people merely witnessing such an event can bring on these disorders.
The emotional symptoms include intense fear, re-experiencing the event when triggered by thoughts, sights or sounds or smells associated with the event. War, natural disasters and un-natural disasters, near death experiences from almost anything all qualify for “out of the normal experience.” Drive-by shootings you are not accustomed to as part of your neighborhood experience fits right in there also.
All that other racial/historical data at the beginning of this story has a point. To a lot of guys, death in the street is so commonplace and so not out of the ordinary that they don’t consider such death as an exposure to an extreme dramatic event and they seem to be defended psychologically (some might even say numbed) to the point that unlike the rest of us, they would not be at high risk for developing PTSD or Acute Stress Disorder. But as I said, my guys weren’t from that place of indifference so the fear of impending death, especially their own, made them prime candidates for psychological problems downstream.
Unless of course they had a few elements on their side. Those elements would include that they had an intact and supportive family. Their wounds were not life-threatening. They seemed to have adequate coping skills and openly talked about how frightened they were. Also it helped that the chief trauma surgeon was an old personal friend as well as professional associate of the social worker who didn’t mind me butting in with his patients once they were medically stable. One of the most helpful things in treating a traumatized patient is to get them out of the emotional moment and move them over to a more thoughtful cognitive view of the events as soon as possible. That move is called reframing,
and every therapist knows to use that when necessary. When the event is reframed to a different issue, it looses some of its emotional power, hopefully enough that the road to PTSD is blocked to the point that the patient has an easier recovery. Reframing can be as much an artful move as a technical one.
In any assessment, start where the client is. That can be done with a simple question as in “Can you tell me what happened?” or by making an observation like “that sounds like a scary situation,” to get the patient talking about the event. Basic stuff.
Fortunately, during the medical interventions, I had time to spend with the boys’ parents standing in the hallway. Bright, educated, focused. They had given me some background about their sons, who had done well in school, had no police problems and were currently in college studying screenwriting and filmmaking and looking forward to a career in show business. Jeez, they could have grown up in my neighborhood, East Hollywood, where half my neighbors were in show business. I had written a couple of screenplays myself.
Reach deep down in that bag of social work tricks, Bob. Help these guys. They have a future and PTSD doesn’t have to be one of the issues in it. I approached the most injured of the boys and introduced myself to quickly define my job.
“Mike, your surgeon says he wants to admit you for the night. Just being careful. But part of being careful is giving you an extra layer of protection and to do that I’m going to give you a false name. An a.k.a. so only people you want to visit and find out where you are and, your parents of course, will be able to get to your room. That protects you. That protects us. I don’t want some banger coming in here to finish you off and take out a couple of us, too. I see you’re studying filmmaking so I want you to be able to use this shooting like a scene from a movie. I’m going to admit you as part of the movie. From now on when you get upstairs you will have a new name: ‘Johnny Chicago.'”
Before he could even respond, and this was a positive sign when his friend, the other trauma — who wasn’t injured enough to be admitted — yelled out from the next bed, “Hey what about me? What’s my a.k.a.? Dude can you give me one too?”
I looked at this chart and he was still listed as John Doe 1937. We usually don’t assign fake names unless the patient is getting admitted because, in the computer, its easier just to roll over the Doe into the patient’s real name. Unless, for some reason, the patient requested anonymity. “Oh Dude, can you give me one too?” was close enough for me as it fit in to my clinical plan. I checked with the supervisor in admitting who had learned a long time ago if I made a special request, I would always have a good reason and more importantly, I would take the hit if they got any heat from leaving the hospital protocol.
“Jimmy New. That’s your a.k.a. As long as you’re down here anyone asking for you won’t find your name in the computer. You get a new name now. Jimmy New.”
Johnny Chicago, and Jimmy New had just been given an opportunity to reframe tonight’s events. So had their parents. I overheard them talking about it when I left to see another patient. Now these were movie guys, like my neighbors. Now they have a different movie with different characters, characters, who they can control, one of the essential elements to avoiding post-traumatic stress disorder.