Part Whatever

I think I dropped the thread of the "My Horrible First Job" narrative long enough ago that it may have a sort of "Uncle Lenny Who Wants to Continue His Story Even Though You're Clearly Not Into It" quality now but hey.

One of the things about this job that I still can't figure out is that I am almost sure it was objectively horrible, but the people there all seemed...not exactly happy to be there, but not to get how bad it was. This may mean that I simply wasn't cut out for it. I get that. But I really don't think so.

How I figured it out was by trying to bond with them over how terrible it was, and getting nothing but a puzzled shrug in return. Even the ones who did hate it there didn't seem to be hell-bent on escape as I thought they should be. Take R, this Russian guy who participated in what I still insist was the clinic's policy of medicaid fraud, though some form of this idea would eventually get me in hot water, which I'm bound to write about later.

So R was a Russian, and Far the Fuckaway is filled with Russians. These are somehow not the same crew as you find down the Fuckaway Peninsula in Brighton Beach, where they have this whole community and their own restaurants and groceries and, it is known to be true, mob, really a whole Russian society in a concentrated neighborhood, bleeding out some into the borough.

Anecdotally, I'd say the ones in FtF were the ones who didn't make it, fell through one crack or another. This is a sample error, of course, because I only saw the ones who went to a Medicaid clinic for mental health, but the neighborhood just had a stench of surrender about it, and from what I know about it, again anecdotally but in any case from people other than myself, it just is not (or was not then) a place you would live if you could make anything else work.

So there were lots of them, and they surely had some combination of depression-the-brain-thing and depression-the-life-thing. But both are treated with meds, because circumstances are expensive to change, and you had all these middle-aged to old Russian people coming in for their meds once a month* and then, because of clinic policy, they'd come in once a week for counseling.

Now this is a good thing. If statistics are your thing, one hears there are studies showing therapy + meds works better than meds alone. I just happen to believe it as a matter of instinct, though I think the question is a bit more complicated, in that therapy helps certain people at certain times, and for instance you can do meds + therapy for a while with depression, and the combination may teach you how to deal better with depression such that you can just keep up your Zoloft or whatever (and maybe drop that too, or maybe not) and not go to therapy forever. Or for other instance, contrary instance, if you are a seriously mentally ill person who is being bombed with antipsychotics because they have to do something with you and people who are on three antipsychotics are usually too sluggish to be crazy in inconvenient ways anyone has to do anything about, therapy is some of the time going to be an exercise in futility.

This was silently acknowledged at Fuckaway. R saw the Russian clients, like twenty of them a day, and billed for full sessions, which is just absurd. I'll never understand how this wasn't caught during audits (ah, audits. The raison d'etre of Medicaid clinics in a way that demonstrates the assumed order of horse and cart these days, or perhaps I mean the agency of dog and tail in the wagging process.) My impression is he would talk to them, give them a little helpful advice maybe if they functioned on that level, and send them on their way.

Some cultures are more therapy cultures than others, if these generalizations ever mean much. Russians, I came to think, didn't see much point in talking about their problems. A lot of them were Jews, and you know, there's a certain culture of expecting and resigning oneself to unhappiness, see also under Freud, Siegmund and Mahler, Gustav. (I know. Mahler converted. But he was what my Grammy Hall would call a Real Jew, and no two ways about it.)

Every one of my own Russian clients--thankfully there weren't many, because I very quickly discovered the difference between language skills adequate to having an informal conversation or ordering a plate of vareniki and a glass of soviet mystery fruit beverage have very little to do with the kind of detailed, can't-skip-a-word-if-you-don't-know it verbal engagement of therapy--I say, every one of my own Russian clients resented our time together and made it clear they wanted their meds and on their way. Maybe this had nothing to do with Russianness. Maybe it had to do with my own poorly masked ambivalence or otherwise my iffy clinical skills. I can't know.

R lived in the Bronx, by the way. His commute was, doubtless, murderous. It's a mystery why he stayed there unless it's because the job was so demoralizing as to leave one in a state of defeated immobility. He was a sweet fellow, and you know what, I think he did quietly** share my bewilderment and disdain for the place. But I bet he's still there.

TBC I suppose...

*The psychiatrists were all Russians. I actually just called to see if one of them still works there because one day she read something inconsequential I wrote as a tiny piece of advocacy for a client and said to me "you won't be here long. You're too good for this place." It wasn't based on much, but it was the only kind thing anyone said to me in 10 months at that place and I think I may drop her a little note and say: I'm in a better place.

**Because I'm on Russia anyway, I thought of a line from Akhmatova: "there, everyone spoke in a whisper." Alright, my clinic wasn't exactly the lines to the prison in Leningrad, but there certainly was a culture of paranoid faked complacency. More on that soon, in fact.