In keeping with the theme of the representation of trauma and its impacts in popular culture (see an earlier review of the film 'His House'), I recently binge-watched Series 1 and 2 of New Amsterdam (the holidays have started, so what?) - a public hospital in New York City.
The handsome quirky, but obsessively dedicated new clinical director - Max Goodwin initiates “How can I help?” as the watchword of his view of “socialised healthcare” for all. Of course, the core of the series becomes the endless conflict between “socialised” (free at the point of delivery) healthcare, and the Board of Directors view of healthcare as dependent on fundraising and insurance companies. (This series does challenge in bite size bits, all of the problems facing the provision of responsive and preventative health care, where it is dominated by insurance companies determining what and who gets funded. A cautionary tale for those who think personal insurance is the way forward for healthcare rather than free at the point of delivery through an NHS model.)
Anyway, onto trauma. In series 2 episode 14, a young Latino boy is brought to the hospital with a carcinoma in his stomach and on the operating table they discover there are multiple carcinomas and of the type likely to return. He is a very bright lad whose mother sacrifices everything to give him a great education at a private school. The rest of that storyline hangs on the discovery that the life-threatening carcinomas are brought on by the continuous stress and brutality of racism, experienced through the daily micro aggressions of institutionalised racism.
(32 minutes in) The discovery is made by resident counsellor Dr Iggy Fromm, (bit too CBT for my liking) who initially fails to detect the stressors in the young lad’s life. In an inspired moment he risks administering the “Harvard Test for Unrest ie designed to measure the level of social resistance which is “ when people of colour oppose the values and policies of the dominant culture” and the possible impacts of this. He explains that the boy’s stress is arise out of the micro aggressions brought on by his daily experience of racism.
Then the fun begins!
When claiming payment from the insurance company, Dr Iggy is informed by “Billing” that ‘Racism” is not an approved ICD-10 code and told, “To change your diagnosis to an approved ICD code ‘cos that’s how we get approved by insurance companies!”
He takes a stand.
Dr Iggy: “Racism can cause life threatening medical conditions, and no-one is doing anything about it
Billing: “There is no evidence base to support this link…… “
Dr. Iggy: because no one is tracking the data to prove it
Together: because the ICD doesn’t have a code for it! ……
Billing: “Ok Dr Fromm go ahead and change the world but not until you change the ICD codes.”
There you have it: treatment =ƒ(data/evidence + ICD category+ insurance companies payout)
So, in the end Dr Fromm encourages the young lad to recognise the nature of racism and name his experiences. He explains that becoming aware and naming is the beginning of understanding it. But (the best bit): whether you can name it or not, he says, the body feels it!!
So in other words cognition does not precede nervous system / environment response to events. Great stuff!! I’ll leave that scene to you all who want to watch Series 2 Episode 14.
And for those who have a little more time to research: Google the 'Harvard Test for Unrest'. And here is the link to a research paper evaluating the work... I wonder what the social resistance questions would show in relation to our health in Ireland as a result of colonial experience over generations. This is something we as practitioners in Ireland need to consider as essential in our work.