COVID-19 BLOG

Living in confinement: a challenge or an opportunity for change?

Tue, 28 Apr 2020 11:39:23 GMT

In the words of Hannah Arendt, human beings are born to begin anew. Listening to clients during the confinement, I have witnessed an emotional response that is fostering change. For many people, this is a process of change that began long ago, but has perhaps been on stand-by, ignored or blocked due to the frenetic dynamics in our lives, societal rules and customs; and our own internal beliefs, ideals, assumptions and values. I am seeing these patterns thrown into question by the current crisis. Faced with an invisible threat, we may have an impulse to fight or flee, but in fact we can do neither: instead, we are forced to sit with our feelings and understand what they activate within us. Here I have attempted to share some of the most poignant moments I have shared with my clients during our therapy in confinement.

Lost time or recuperated time?

‘Sometimes I think I should be with my family in Italy; I feel so guilty for being here,’ says Viki. I ask her what she would be doing for her family if she was in Italy. She says, ‘If I was there, I’d be doing their shopping, so they wouldn’t be exposed to risk.’ Viki is not alone in being far from home during this crisis: in my work as a psychotherapist at Hestia, I meet many people who, like myself, live far from their families of origin and loved ones. The uncertainty of when we will next see those dearest to us and have physical contact with them can be the source of a lot of pain, but it also offers us a chance to replenish those relationships.

The fact is, Viki tells me that her relationship with her family has become closer than ever through this crisis: she speaks to them far more frequently than usual, and their communication is better now. They have more time to talk, and more interest in sharing how they feel, because they are worried about each other’s wellbeing. During this ‘lost time’, they have rediscovered – through their urge to care – their love for each other. Of course, they are missing all those things that are only possible in person: hugs, touch, physical contact.

Viki’s experience has made me reflect on something Professor Cancrini mentioned in a recent interview . When we are reunited, ‘We will hug each other with more enthusiasm, having reevaluated all those things that we used to take for granted’.

The importance of being productive

The question of being unproductive has also often come up more than once with clients recently. The ‘doing nothing’ is taking its emotional toll. Barbara explains that, without her usual routines, she feels vulnerable, because her work, studies and daily activities previously allowed her to construct an image of herself as strong and independent, based on the logic that ‘duty comes before pleasure.’

During the isolation, my sessions with Barbara always begin in the same way. I ask her how she is and she answers, ‘I’m okay, but I don’t get anything done.’ We’ve explored what it means for her to get things done. She says, ‘Going to work, having established routines makes me feel alive. Having lots of free time and not knowing how to manage my day makes me feel I’m not making the most of things. I feel useless.’ Barbara’s time is marked by a series of activities that she enjoys, though she struggles to allow herself to do them, because they fall into the ‘pleasure’ category. To spend time playing an instrument, relaxing, cooking, reading, speaking with friends seems a waste. As the weeks have passed, however, she has used the time that at first seemed ‘lost’ to rediscover things that make her feel alive. In our last session she told me she is feeling much better; that the pressure to be productive has reduced. She has realised she does not enjoy the job she was doing. It’s the first time she’s ever told me this. ‘I felt the pressure of my mother, who always prioritised work over everything else.’ Our sessions have changed; they have a new vitality to them.

Going home; a moment of freedom

One young client of mine, Margarita, decided to leave Spain and go home to spend the quarantine with her family. When she got there, she decided to take a break from therapy. ‘I don’t want to talk about my problems at the moment; I’d like to continue once we get back to normality.’ Margarita’s anxiety and anguish and even her dysfunctional eating behaviour appeared to reduce the moment she got home. It was as if she was experiencing a new beginning, after many years of living abroad. She felt some hope that things were going to be different; that her relationships were improving. She had great hopes that her parents would no longer be fighting the way they used to fight.

Margarita left home to study abroad; but she also wanted to escape a family environment that was full of conflict. She left to find peace. She tells me that she hopes her parents will help her overcome her eating disorder. This is a surprise for me, as she’s always said she does not want to tell them how she’s suffering; she does not want to worry them. ‘They have their own problems; the last thing they need is to deal with my bulimia,’ she has told me in the past. Now something has changed in her internal world. It seems that she has begun to listen to herself and to prioritise her own needs.

There is no escape

Joana tells me, ‘I’m frightened of being alone. I’m scared I’ll lose control and pour all my worries into food. When I get out of control, I feel so guilty and ashamed.’ These are the very emotions she’s been fighting for a long time; what has changed is the context. Now it is just her and the emotions. There is no escape. She cannot go outside and disconnect via her usual means: drugs, alcohol, food or dysfunctional relationships.

Joana wants to come out of this experience having somehow benefited from it. She wants to stop trying to escape. She wants to pay attention to what’s happening; to give meaning to her pain and suffering; to understand her anxiety. She is discovering whom she can actually count on; which relationships are real; who genuinely cares. Paradoxically, she feels less alone, because she is experiencing a new reality. She has chosen to put her internal chaos in order, by accepting what is outside.

Obliged to stop

Carla has been talking about how the pandemic has forced us to stop; how our daily life has been transformed with the quarantine. Until this happened we felt such a necessity to race around, in the belief that whoever stops is lost. Now it’s the opposite: we have to stop if we don’t want to be lost. Carla has been experiencing a sense of peace at having slowed down the rhythm of her work, friendships, love life, and exercise. At first this terrified her, but she’s come to realise that the way she was living, it was as if she was running a race. ‘I always compare myself with others and think I’m inferior. I don’t have a partner, I don’t have a secure job, I don’t have any prestige.’ Every day felt like a test. And now that everything’s stopped, everyone is in the same boat.

For Carla, there is now no space for comparisons; instead, she’s started listening to herself. She recognises the good things she’s built and accepts there are things in her life that aren’t perfect. She continues to work on the grief she feels at losing her father, and the poor relationship she has with her mother, as well as the insecurity she feels about the future. She accepts all of this. She is not in a hurry. She accepts whatever gives her pain; she wants to manage her emotional void, dedicating time and space to it.

Every day we are witnessing – directly or indirectly – pain and suffering. But we are also witnessing hope. We are looking at the other with more interest and greater empathy. We are looking inside ourselves, becoming more aware of our feelings and experiences. We feel more compassionate and more passionate, too; for what we do not want in our lives anymore, and for what we yearn for. It is the kind of passion that can mark new beginnings. And then maybe we can be reborn. We, ourselves and the world as we have known it.

Disclaimer: names have been changed to protect confidentiality.

Written by: Adelaide Margiotta- Translation by: Amy Bramley

Interview with the psychiatrist Prof. Luigi Cancrini

Thu, 16 Apr 2020 13:37:28 GMT

Interview with the psychiatrist Prof. Luigi Cancrini

‘This is a time for care, not hate.’

By Simonetta Fiori

Original article: https://rep.repubblica.it/pwa/robinson/2020/03/28/news/lo_psichiatra_cancrini_questo_e_il_tempo_dell...

On fear for the future, solidarity, patients who feel ‘normal’ and normal people who feel ill. Reflexions on mental health.

‘This is a time for care, not for hate. A time for listening and for sharing pain that is good for all of us; even for my own patients who are playing out the most horrible fantasies in their internal worlds.’ The pandemic, through the eyes of Professor Luigi Cancrini, one of the greatest Italian psychiatrists, is an opportunity for rebirth, for regeneration. ‘It is a chance for everyone to discover closeness and solidarity – our most important resources for living better.’

Eighty-one years old and with an impressive career behind him, Cancrini founded the Centre for Family Therapy and Human Relations with Franca Basaglia in the 1970s. He sees the centre as his professional home.

Professor Cancrini, we are experiencing solitude, fear, death, pain and the suspension of our freedom. Many people have compared today’s unease to the experience of a war.

‘I have a very vivid memory of the bombings of 1943. We lived close to San Lorenzo, a Roman district destroyed by the Anglo-Americans, and I remember well the terror, the deafening sound of the airplanes, the sheltering in basements. But we are talking about very different experiences here.’

Why?

‘War is a time of hate. In war, in order to survive, you are forced to kill others. As De André says in his song, Pierro dies because he hesitates to fire at the enemy and he pays for this hesitation with his life. In contrast, today is a time of closeness and solidarity. The enemy is external to humankind; men are obliged to unite to face a common threat.’

Fear is making us find closeness?

‘Yes, this happens when everyone shares a common enemy. I was struck by the motto: stay at home, you’re doing good for yourself and others. The idea that helping oneself is also helping others gives an emotional impulse that strengthens solidarity.’

A feeling far from the recent collective mood in Italy, diagnosed by different psychoanalytic societies as ‘psychopathic’, ‘paranoiac’, ‘authoritarian’ and ‘intolerant’.

‘I would use different terms. Our country, like the west as a whole, is suffering from narcissism. Having anything we want at our disposal, we tend to feel omnipotent and, at the same time, distrustful of our neighbours, whom we see as a threat. The experience of coronavirus is forcing us to face our limits – we cannot have everything – and we need solid relationships: it might be the best remedy for our narcissistic disorder.’

Have you observed a change in your patients during this time?

‘I am struck by the reaction of those with psychotic disorders, patients who are capable of terrible fantasies, who project their internal world onto the external world. Now that this threat figures in everyone’s imagination, these patients feel more ‘normal’, equal to others. They actually feel better like this.’

Being exceptional might liberate unexpected energies?

‘The literature of psychiatry tells us that many seriously ill individuals get better during times of war. Suicide rates go down, because in times of danger the survival instinct takes over. For the human mind, dealing with an internal enemy is far worse than dealing with an external enemy that we are defending ourselves against collectively.’

Is this true even for those suffering from addiction?

‘Yes, people living with addictions tend to be escaping death via bewilderment and by hiding from reality. When you need to be on alert to destroy an external enemy, all this disappears.’

Do these reactive mechanisms also disappear in people who don’t have particular pathologies?

‘Of course. And that feeling of closeness that we spoke of earlier is reinforced. When the emergency is over, we should attempt to keep this intact; closeness and solidarity are the most important resources for living a better life. I’m afraid that when the virus disappears the cohesion it has created will be missed. I’m already seeing signs of this in some of the discussions on talk shows.’

What advice could a therapist give for cultivating the vital flame during this difficult time?

‘In psychoanalysis we say that a good therapist is one who knows when to hold silence. In silence, emotions, respect, concerns, doubts and verbal communication limits are transmitted. At this time, each of us, in our homes, may be compelled into a silence that could bring us to a better relationship with ourselves and with others.’

Are you experiencing this transformation yourself?

‘Yes. While I’m continuing to see patients who have a great need for the therapeutic relationship, I have more time for myself, to read my dear Russians, to listen to classical music and to play the piano. I watch the trees from my window, something I have never done. And I’m dreaming a lot: remembering dreams is a sign of recuperating your relationship with yourself.’

Once the health emergency is overcome, the economic and social crisis will be overwhelming. Is there a risk of returning to an even fiercer individualism?

‘Yes, of course there is. Everything will depend on how this crisis is managed: whether it is done in solidarity or via oppression. As a man of the left, I watch with sadness how nowadays in Europe the strongest countries reject solidarity with those are weakest. And the huge speculation on the stock exchange frightens me.’

Like all collective trauma, coronavirus will leave its mark. Among the cruelest symbols of this pandemic will be the solitary parade of coffins. People are dying alone. We are impotent witnesses of the solitary deaths of our loved ones.’

‘It is a distressing and terrible aspect, but in these life experiences there is a closeness and collective exchange that we were hardly accustomed to. Certainly, mourning rituals are central to working through loss. Being unable to cry and to hug together at the time of burial could leave deep wounds. Many pathologies that I face are related to grief that has been left unelaborated.

Will we hug and kiss again with our previous carefree joy or will unconscious fears act within us?

‘We will do so with more enthusiasm, giving a new value to everything we used to take for granted.’

You have defined coronavirus as the time of solidarity and cure. Committed front-line doctors and healthcare workers symbolise this.

‘Freud said that the doctor’s vocation came from a desire to heal one’s own parents. I think that in many vocations within the healthcare profession, there is a profound feeling of love for humanity. They are the ones who should lead the transformation of the community we must deal with: it is the best way not to succumb to despair.”

Translation by Amy Bramley, HESTIA, International Psychotherapy Centre.

Therapy in confinement

Thu, 09 Apr 2020 19:03:46 GMT

Reflections on the psychological effects of COVID-19

As we approach our fourth week of confinement here in Spain, my work as a psychotherapist has taken on a new meaning. Ironically, despite working online, I feel closer to my clients. No matter how hard the content of our sessions, I come out of them feeling more human, more connected. Many of those I work with are isolated alone, their daily lives changed beyond recognition. And perhaps because of the universal nature of this shock, I feel as if the bones of therapy have been stripped bare: the very process of connecting, talking, being heard is in itself enough. The human dimension – and by this I mean the simple fact of our relationship – is forefront.

‘It’s showing us what a fragile construct mental health is. Mental illness is so societal, so contextual,’ a colleague said to me a couple of days ago. ‘Suddenly anxiety and fear are natural responses. The new normal.’ I think about this a lot as I work with my clients this week. There’s much being said in the media about the ‘new normal’ we will emerge to once the pandemic is over. It’s enough to terrify us all. Mass unemployment, economic collapse, closed schools, restricted movement, widespread surveillance, a non-existent high street – the list goes on. But I wonder if there is a bigger change occurring, too. ‘Life has no meaning the moment you lose the illusion of being eternal,’ to quote Jean Paul Sartre. Optimistically, perhaps, I wonder whether in place of ‘no meaning’ we might find a ‘new meaning’ in togetherness and community. We might begin to talk more openly about and accept the fear, anxiety and sadness within ourselves and help those who are overwhelmed by it. Being forced to slow down, while being exposed to daily death tolls and fear mongering, might push us to look at ourselves and others differently, more honestly, more compassionately.

I have clients for whom anxiety has long been an almost inescapable way of being. One of them was in such difficulty when she first came to see me, she wouldn’t eat for days. She was thin and brittle as an anorexic, taking cocaine and ketamine most weekends. She would appear every Thursday, huddled in the waiting room, a hat pulled down so low you couldn’t see her face. Time and time again she would tell me that therapy was her lifeline. It was how she was going to turn a corner. And turn a corner she did. When we meet today, we reflect that she is in a better place to deal with this crisis than she’s ever been in her adult life. She hasn’t taken drugs since last year; she’s come off antidepressants; she’s been going to the gym since January and is now exercising every day in her bedroom. She makes an effort to cook for herself and has put on a little weight. ‘I’m actually not feeling anxious,’ she says in our session, ‘I should be and everyone around me is, but I’m just feeling a bit low. I’d rather feel low than anxious. If I was anxious, I couldn’t do anything, couldn’t even sleep. I look at how my friends are coping – getting hammered, off their heads. That could be me. But it’s not me. I’m grateful.’

This preference for sadness over anxiety has struck a chord with me today. I think about how chaotic and utterly overwhelming anxiety can be. Almost like a demon that possesses us, stretching everything so tight it might snap: our voice, our nerves, our breath, our capacity to be present. I think about sadness, about depression. How it drags us down to the bottom, slows us to a stop. Anxiety sends us spinning; it freezes us at full pitch. I can almost understand her preference, though I have never thought of it in these terms. I underline the words in my notepad and I see a pattern: gems of wisdom are coming out of my clients’ mouths on a daily basis with this crisis. One client is so articulate this morning on the feelings I’ve been having about what the pandemic is teaching us, it’s as if she’s entered my own head. ‘Normal is out the window,’ she says. ‘Everything is a construct. We’ve never had this free time before; it’s got to change us.’

Another client has a friend with the virus who is in intensive care. ‘I know I said last week that life goes on,’ she says to me in our session, ‘But I’ve realised that life doesn’t go on. Not for everyone. That’s the reality.’ There is a sadness about her when we speak, but at times – despite everything that is happening – we manage a smile, a laugh. She tells me that yesterday she took her friend’s dog to the vet and made the mistake of telling the receptionist its owner was in hospital. ‘But I haven’t visited her in ages,’ she told the receptionist, when asked to wait out in the street. ‘I picked the dog up from her son, I didn’t even go inside. He let the dog out to me.’ This explanation did not reassure the receptionist. ‘So I went out and stood there and cried,’ my client says. ‘The woman was just doing her job, I know that. Why do I overreact? Why do I cry so easily? I didn’t cry when my sister died, but I cry at the smallest thing. I wish I could toughen up.’

It is a strange sensation for me, listening to her recount this experience. I can visualise the scene so clearly, almost as if it was me who took the dog, me with the friend in hospital. I can imagine myself having that very same reaction at the vet’s. It feels human to me to be so on edge, to be so sensitive considering what we are living through. I tell her this. ‘I can’t imagine you reacting like that,’ she says. ‘I can’t imagine you ever reacting like that.’ I very rarely share personal information with a client, but this time it feels appropriate. I tell her I didn’t cry when my mother died, either. I say I, too, cannot explain it, but often the big things are when we can’t cry. ‘I didn’t know your mother had died,’ she says. ‘I’m so sorry.’ We sit for a while in silence, looking at each other through the screen, a slight smile on our lips.

My youngest client lives with her parents and brother. She came to me suffering from anxiety and depression months ago. From the very beginning, therapy was as much about giving her the space to explore her experiences and feelings, as helping her to go out into the world to make her own way. When she came to therapy, she was spending all her time at home, much of it in bed. Gradually, things shifted. She got a job and was going to the gym until the confinement started. Now her anxiety has returned with a vengeance. She senses she will struggle to go out again once it’s all over. She enters our first online session, her eyes welling with tears. There are arguments at home – between her parents, with her brother. They’re driving each other mad. When I ask her to elaborate on the anxiety she’s experiencing, she says she feels constantly guilty – that she’s not a good enough daughter, she’s putting on weight, she’s regressed during the quarantine. I ask her to find the feeling in her body: where is it? What is it? She says it’s like a burning in her stomach. We do some breathing. Afterwards, she says it has lifted. She tells me about her brother: he failed two subjects at school and she’s been helping him catch up. ‘That’s nice,’ I say. ‘To have the time to help him.’ ‘It really is,’ she says. ‘I’ve realised how hard it is for him. He’s always compared to me. I was the perfect student. He struggles.’

‘There’s no room for FOMO anymore,’ one of my clients says. ‘I mean, who is there to envy? I didn’t even envy the Londoners who ignored how serious this is, going out to the pub when they were told not to.’ He says he’s been chatting with a girl he’s known for a while and really likes and he’s happy he can’t see her, because usually he’d be rushing to sleep with her. But now he can’t. ‘Maybe this has come at a good time for me. Maybe I needed it,’ he says. ‘Life has really slowed down.’

One of my clients is a doctor who has voluntarily flown back to her country of origin to work in emergency services. She is now stuck in quarantine for two weeks before being allowed to start at the hospital. We connect during this period. She’s been told there won’t be any protective clothing for her – they’ve almost run out. She’s struggling with the risk this poses both to herself and to her patients. She says, ‘If I was in this position a year ago, I’d have had a meltdown, but somehow, though I’m scared, I feel ready.’ Why does she think she feels ready? I ask. She has always been skeptical about therapy. She is a scientist through and through – she needs evidence things work. But today she says, ‘Maybe there’s catharsis in talking. I don’t really know what I think has done it. I’m feeling grateful for what I’ve got. More comfortable with who I am.’ Then she says, ‘What do you think has done it? How do you think therapy works?’

After our session, I find myself sitting down to write about therapy: what it is; why and how I think it works. I’ve often marveled that I am being paid to sit and listen, with my full attention, to other people’s most intimate monologues. I will never tire of the stories people have to tell. I will never run out of empathy for the trials they have endured. And although therapy is not just about being heard, I know this is a major part of it. There is something remarkably therapeutic in the opportunity it gives us to clarify and tell and retell our stories with a private witness who has nothing to do with our own lives. A private witness who, by their very calling, is there to help us clarify, and there to be on our side. So many of us are not heard – cannot even hear ourselves think. Therapy is a process of helping a person understand their own wounds; helping them understand their actions and reactions, too; allowing them to see and call out the core beliefs that drive them and that, perhaps, hold them back. In the systemic school, therapy is about seeing ourselves within a web of relationships that mold and drive us in ways we are often unaware. The attempt to define and describe therapy could go on and on, but I still maintain that fundamentally it is about being heard.

I write this and hesitate. I am missing something. There is something else I have tended to see as secondary to the ‘being heard’, and that now, during the Coronavirus crisis of isolation, I am seeing as primary: therapy is a relationship. Where other relationships might have let us down, this is a relationship that remains constant, reliable and prepared to face whatever suffering is thrown its way.

‘I’m the best I’ve ever been,’ says one of my long-term clients. ‘This is the sabbatical I’ve been dreaming of. I’m mentally so rested. It’s really weird. Around me everyone is getting depressed.’ He is relieved to have broken the boring routine of getting up, rushing to work, listening to podcasts, dealing with shitty company politics, rushing to the gym, feeling obliged to socialise. ‘I’ve realised I like this time alone,’ he says. It’s given him the space to reflect on what went wrong in his last relationship, too something he found challenging before. He can see how rigid he was, how much he had going on, how little time he had for her. ‘Why push yourself so much?’ he says. ‘Relax! Relax!’ I feel, for a moment, as if he’s talking straight at me. ‘People are so used to getting what they want, whenever they want it, all the time,’ he says. ‘Now we can’t. We just can’t.’ I tell him it sounds as if the experience is like therapy for him. Accelerated therapy. ‘It is,’ he says. ‘I can finally see my life from the third person.’

Tonight, I get a message from a doctor friend here who is working on the front line. ‘How are you? Are you going mad!?’ he asks. He says he feels like he’s living in a nightmare. ‘It’s the hardest work I’ve ever done, the hospital is full of pneumonia. Colleagues are sick, some have died.’ He tells me to expect it to go on well into May. And then he says, ‘Stay strong, healthy and isolated: the most important thing! Look after each other. Together we will get through.’