When major cities like NYC and Paris shutter cultural and educational institutions, even restaurants; all of Italy is on lockdown; borders are closing between nations in Europe; international travel restrictions and possible domestic bans are in place, it can feel like we are gearing up for war, that the apocalypse is coming. And we are scared.

We must trust that these measures and restrictions are wise and necessary, but some do not, and fear they are just shots in the dark because we don’t know what’s really happening. They ask, if something Really Bad out there isn’t threatening us (“Something Wicked This Way Maybe Comes”?), then what else could these dire precautions mean?

Timing-wise, the virus scare here in the US reached crisis proportions in the week after it became likely that Joe Biden would head the Democratic ticket. Primaries have been cancelled in several states. Some fear that Trump could declare a state of emergency, postponing the general election thereby extending his term as he once threatened to do. Fears about economic stability also abound as the stock market gyrates wildly and remains unsettled. The situation is rapidly shifting, fluid and unpredictable. Can the center hold?

As great uncertainty about our immediate safety and security mix with conspiracy theories, a dearth of consensual information, and a profound absence of reliable or competent leadership at the helm of government, we can feel collectively traumatized – unmoored, disoriented and disorganized, derealized, hypervigilant, helpless, and afraid that nothing and no one from “above” will help or rescue us.

This psychic configuration can result in increased annihilation anxiety and paranoid-schizoid slippage, both of which are likely to be amplified in the context of a plausible threat to the health and well-being of ourselves and our loved ones. In an inner world in which there is no good Rescuer object, there are only Victims and Perpetrators (Karpman, 1968), and often an excruciating unmet longing for reprieve. When that longing is dissociated, when hope fades away, and there is no mediating Third, dialectical space collapses and we need an empathic “other” to reestablish reflective capacity (Gerson, 2009; Wigren, 1999).

What is our role as therapist/analyst in such a situation? How can we help when these are experiences being shared with our patients in real time? Can we think usefully about anxiety, fear, panic, and terror when we too are under their inhibiting influence? In the vein of Shengold’s concept of “too much too muchness” (1989), what is there to analyze when there is too much Reality?

Traumatic reactions, as we know, are characterized by fight-flight-freeze responses that occur automatically when, in moments of terror, our “upstairs brain” goes offline, disabling coherent thought. When we get caught in rigid oscillations between states of psychic numbing and flooded overwhelm, we can’t assess or develop an adequate solution to address our fear.

As psychoanalysts, we are in a unique position among all health professionals in this regard. Our training teaches us to become skilled participant observers. As contemporary analysts, we toggle our awareness between our own moment-to-moment internal experiences with each patient, and attention to our patient’s explicit and implicit communications to us. We reflect, both silently and together, on these mutual experiences, seeking a therapeutic growth edge, alert to any novel understanding that may present itself for discovering.

We listen, sense, feel, reflect, think, respond, and process.

To do this to best effect when under stress, we need to slow down inside in order to track the flow of the immediate and unfolding therapeutic process. We tune in to find a rhythm that supports a felt sense of presence and gently assists the deepening of here-and-now internal and relational connections. From this stance, we may talk about fear more safely, and thereby loosen its grip.

As with most of the problems in living that patients bring to us, our work consists of helping them to know themselves as authentically as possible; to identify their own opinions, values, meanings, and plans for how to live them. We strive to help patients construct enough personal agency to carry out their chosen paths with conviction.

In line with these time-honored analytic principles, one important way we can assist patients is by helping them to make sense of their personal responses to the crisis by carefully differentiating defensive from more adaptive coping strategies.

Here are a few brief examples:

• An asymptomatic person who had determined to self-quarantine was able to see that she was enlisting the crisis as justification for acting on her chronic depressive tendency to isolate.
  
  
• By contrast, a retired elderly person who lives alone was so anxious about becoming disconnected that she denied the need even for conservative measures such as appropriate extra hand washing.
  
  
• Another person was full of haughty and sarcastic humor talking about it, reveling in her feeling of superiority for not being “hysterical like everyone else.” Her narcissism became so bloated in an attempt to disavow any sense of personal vulnerability that her omnipotence had to be countered.
  
  
• Finally, one highly anxious and tightly organized patient who used compulsive stove-checking rituals to calm herself reported that she hadn’t checked her stove for a stretch of days! It was as if the raw magnitude of validated social panic had, without any effort of hers, obviated the need for her to hold all of her anxiety inside. From a drive theory perspective, we might say that we witnessed a redistribution of her psychic energy. Poignantly, the OCD symptoms had originally emerged at a time of extreme personal crisis during which there had been only scant acknowledgment offered. This last vignette is one that calls our attention to the dynamic and mutable relationship between inside and outside.

We all need ways to center and ground ourselves in the face of high anxiety. Belief in the efficacy and relevance of our analytic work and community can provide us with a crucial resource to help us go-on-being in these troubled times. In these ways, even while working in the context of the current COVID-19 crisis, we may find some safe harbor in our trusted, familiar, perhaps even cherished analytic values, knowledge and methods. It is a kind of faith that can guide us.

 

Sandra L. Green, LCSW-R, SEP, is a certified psychoanalyst, licensed psychotherapist, and Somatic Experiencing Practitioner. She is executive director, clinical consultant, and faculty member of the Certificate Program in Trauma Studies at Manhattan Institute for Psychoanalysis, where she also teaches and supervises in the psychoanalytic training program. Sandra also teaches advanced seminars in trauma at ICP and PPSC in New York. She is in independent practice on Manhattan’s upper west side.  

 

References

Gerson, S. (2009). When the third is dead: Memory, mourning, and witnessing in the aftermath of the holocaust. International Journal of Psychoanalysis. 90:1341-1357.

Karpman, S. (1968). Fairy tales and script drama. Transactional Analysis Bulletin, 7(26), 39-43.

Shengold, L. (1989). Soul Murder. New Haven: Yale U Press.

Wigren, J. (1999). As hardly killed, as easily wounded: Posttraumatic challenges to the working alliance. Contemporary Psychoanalysis. 35:253-269.    

 

To contribute to the special series on COVID-19, send blog posts of up to ~1,000 words (read full submission guidelines here) to Analysis Now blog co-editors Justine Duhr at justinetduhr@gmail.com and Robert Levin at rob@robertlevinlcsw.com.

 

 

 

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Special Series on COVID-19 by Justine Duhr, MFA, and Robert Levin, LCSW