I made the above Psychological First Aid infographic based on some of the training resources I used during my own PFA certification process, mostly as a training tool for others doing similar courses, but also to use in some more Transformers analysis of medic characters LMAO
You can see some of my PFA sources, including the source for the above, in this post where I discuss Ratchet’s good PFA practices in TFP.
Click to enlarge the PFA information sheet! :)
At the moment, I’d like to talk some more about Transformers psychology and mental health– This time, using Rung as an example!
Cybertronian Psychology: What We Know From Canon
We know that Psychology is an established field of practice on Cybertron, with several different mental health specialities being noted in various TF continuities.
Froid and Rung are the best known, while Blot and Bombshell are Psychologists in the SG universe, among others.
But first, it’s important to note that Rung is a Psychiatrist, not a Psychologist!
Here’s a helpful resource for you to learn the difference, which I have summarised for you below:
Psychiatry: The study of mental health problems and related diagnostic processes, management of mental illnesses, and prevention of mental illness.
Psychology: The study of people, all aspects of behaviour, and the underlying sources of behaviour (thoughts, feelings, etc.).
Rung is a medical doctor, at least by human standards, as Psychiatrists are clinicians trained in mental health as a speciality. By Cybertronian standards, we have seen that mental health specialists on Cybertron tend to be mostly if not entirely separate from the general medical staff, which may be a matter of organising healthcare services by category based on a specific Cybertronian system of medical provision.
As Rung isn’t ever referred to as a medic in the same sense as First Aid or Ratchet are, it hints that there are some key differences in how various medical staff may be trained, treated, or perceived based on speciality.
This division of certain care services may have been influenced further by the war, demanding that hospitalists/clinicians be deployed as field medics, while mental health care teams may have been positioned at bases or in more defended areas to allow for post-acute injury assessment, follow up, and so on.
This allows for emergency mental health support teams, such as disaster response, acute or emergent mental health care, and so on– While also leaving mental health experts on hand at bases or other areas to ensure such care is available and accessible as much as possible.
We see that Ratchet does hint at referring cases to Rung, or receiving referrals for patients from Rung, so we know there is a multi-agency healthcare approach– At least, on board the Lost Light.
We see him carry out the following work, here and there:
-Therapy and Support Sessions
We don’t know what various methods of therapy may exist, although from what we see in MTMTE, he seems to provide initial assessments, follow-up sessions, individually tailored therapy, and general mental health services.
Addressing and following up with patients who have experienced immediate trauma.
-Mental Health Intervention
Taking on acute cases or referred cases to step in and assess + provide appropriate mental health care.
-Provision of Referrals to Med Bay (Additional Care Services)
In many healthcare systems, direct referral is referring a patient over to a specific named clinician, where a general referral is passing the patient to a service or hospital department etc. to determine who will see them and when.
In the context of the Lost Light, Rung seems to be able to assess a patient and determine they are at risk; At that point, he has a direct line to the CMO (Ratchet), which we see evidence of at least twice on panel.
Two things can then happen:
General Referral: Ratchet can then assign the patient to another medic to make an appointment and follow up. This is a non-emergent option, meaning if a patient is deemed at risk or in acute need of further care, a direct referral is preferred.
Direct Referral: If the patient requires more specialist care, Ratchet may be named to take the patient in as “acute priority” for himself, meaning that he will pick up the case as he is the most experienced clinician available in their Med Bay. He will then see the patient as immediately as possible to address any concern(s).
If another clinician is named (First Aid, Velocity, etc.), then they will have the “acute priority” patient and carry out the same process from there.
The methods used for identifying patients at risk can be complex, and it seems that in Cybertronian psychology, there are some similarities in assessment processes compared to real world risk assessment.
Here is a guide on good practice for assessing risk, provided by the Royal College of Psychiatrists.
The above document gives a good idea of what “red flags” or concerns may be of note, and how to potentially handle a patient who may present a risk.
This process may vary for Cybertronians, but possibly not by very much, as a lot of risk assessment is designed to be somewhat general as each patient must be assessed individually whenever possible– There is no universal assessment process, as factors may vary significantly from patient to patient/situation to situation/etc.
However, due to the differences in the physical aspects of the Cybertronian mind, there will inevitably be some serious deviations from real world practice.
Many of these have extremely frightening possibilities; For example, note the panel below:
With humans, many mental health concerns may have chemical imbalance or other organic/physical element as a significant or secondary contributing/compounding factor.
But with Cybertronians, their minds are essentially computers.
Far fewer chemicals involved, compared to the number of mechanical components that may also present similar mental health concerns if any of those components should be damaged or working improperly.
So, in a way, that difference is a similarity!
Even so, the physical differences in relation to the mind are still significant to note:
In the panel above, Rung is discussing a patient that has been deemed to be at risk by Froid, who has elected to employ extreme methods of “treatment”, seemingly in an attempt to resolve the mental health concern.
Personality adjustment, in this sense, is to essentially re-write someone’s personality. It’s not an effort to see if further support may help change or improve someone’s wellbeing. It’s literally saying “your personality is bad, and it’s very hard to fix, so we’re going to give you a new personality.” YIKES.
In human beings, addressing personality concerns is an extremely complex and lengthy process. Our brains form physical pathways, and physical and psychological factors are both heavily involved in personality development, resultant behaviour patterns, and so on.
With Cybertronians, you can get a mneumosurgeon to step in (likely via referral, as there seems to be an established care pathway for this process) and just… Clean out the mind. Literally.
This is alarming for a lot of reasons, but primarily because of this key point:
Cybertronian mental health services do not seem to require patient consent, only the consent of a lead physician or healthcare professional.
We see time and time again that it is not the patients being directly asked questions about their care or treatment methods, but rather, whoever is deemed to be “in charge” is asked instead.
Patient Care: Ratchet vs Rung
Even Ratchet pushes it a little sometimes, when he occasionally pushes back now and then whenever a patient chooses a care option that he has not recommended or approved of himself, even when that patient is well informed and has stated their wishes repeatedly.
(Yes, even if a decision isn’t the best clinically speaking, a patient still has the right to determine how they would like to proceed with any medical care– Or even to proceed without any further medical care.)
Of course, patient consent as we understand it is based on real world, human medicine. We don’t know what Cybertronian patient rights laws or practices might be in place.
For example of a real patient consent framework, you can find a good outline of informed consent according to the Council of Europe’s Convention for Human Rights right here, as published by the European Commission.
In context, Ratchet’s push back is sometimes understandable, such as when a care option chosen by a patient may be potentially seriously dangerous for the patient or for others.
But it’s still worth noting, as such push back (especially with Ratchet’s usual grumpiness and his status as CMO lending him significant authority in matters of patient care) can sometimes cause a patient to question themselves, leading to them giving consent for a procedure they didn’t really want for example, or leaving a patient confused or unwilling to engage as much with medical staff in the future, in a way that can lead to unwanted or unintended outcomes of care.
It seems as though the war has compounded serious problems with patient consent in Cybertronian medicine; Problems which were already established as being par for the course prior to the war.
There are several reasons for this, including political influences on medical best practice guidelines before the war even started, which resulted in all sorts of horrific medical practices and procedures being carried out. This includes, of course, empurata.
My father was an Army Medic who was part of MEDIVAC/CASEVAC, and… Let’s just say that providing care while under active fire is wildly complex and difficult for all involved, and the triage process is the framework for pretty much everything after a certain point.
In conditions of war, patient consent gets complicated, too. Typical care frameworks are likely unable to be applied or are not applicable in such situations, the battlefield/wartime specific frameworks for patient care that do exist may not be applicable in all scenarios– Medical ethics and patient care in the context of war is extremely complex.
Rung, from what we see in canon, seems to have retained a very firm and possibly somewhat uniquely kind and patient-focused set of personal professional ethics. He doesn’t seem as weighed down by the war and any necessary deviations in practice standards or procedures, in contrast to Ratchet, who we know deals with at least some degree of trauma around perceived failures to provide adequate or successful care under the conditions of war.
We don’t know about all of what he did during the war, but we do know that he was unsatisfied with the way things were prior to the war, and we know that he did not give in to poor standards of practice even when other leading professionals in his field capitulated to political pressure, social pressure, and constantly slipping care standards.
Ratchet has also maintained strong professional ethics and upholds excellent practice; We know he was also upholding personal professional standards far above those expected of him during the pre-war period.
However, his patient care can be a little more questionable here and there, with his grumpiness sometimes causing him to forget that not everyone will respond well or tolerate the more gruff approach that he developed out of necessity for himself and others during the war.
(And we all know how his advice to Drift went down pre-war… Not the smoothest, although he is seemingly not trained in providing emotional support for certain at-risk patients such as Drift was at that time, lending to my theory that specialisation works differently in Cybertronian medicine. Which would explain a lot. I will make another post about pre-war Drift and Ratchet’s interaction, later, to cover it in-depth!)
This is not to compare them too directly, as their situations and experiences vary significantly, and of course, we can’t compare Ratchet to Primus Himself…!
But Ratchet and Rung are great examples of using patient focused practice and standards to disregard common/legal but harmful protocols in favour of actually preventing harm and actively addressing healthcare concerns, particularly for those most in need.
Rung and Maintaining Duty of Care
He takes on significantly at risk or “dangerous” patients, such as Whirl, and continues to maintain ethical and professional standards even when under duress or at risk of harm for specifically doing the morally and ethically right thing.
He even names Duty of Care as his reasoning for maintaining patient confidentiality, even when the patient himself is threatening him for doing just that.
This is a good document provided by the Australian National Mental Health Consumer and Carer Forum, which outlines some key Duty of Care basics.
It’s almost time for me to get ready for my actual job at a clinic lmao, so I’ll leave this post as-is for now.
As always, sorry for the length, but I hope this is interesting to someone! :)
If you read all of this, thank you!!! <3
