A deadly pestilence is on our town, strikes us and spares not… – Sophocles, Oedipus Rex

#Covid19 #domesticviolence #childabuse #mentalhealth

Most of us are struggling right now, doing our best to sort through the stresses of the American mortality numbers, massive change in the economy, the loss of personal contact with family and friends, the inability to do the simple things one does that makes life enjoyable- dinner out, a movie, the gym.  Now we have isolation.  Our life styles have taken a huge turn.  And at the same time, the question of our own mortality has become present.  Bottom line— we question how much control we really have over our lives.  Depending on our fiscal and social arrangements, this may range from an uneasy time to a frightening loss of control.  

We are confined, for our own good.  If that place is mostly kind and caring, we can flourish.  If not…  Here is the one situation where I could agree with the infamous Sartre quote – ‘Hell is other people.’  His play, No Exit, is about three people trapped in a room together, with no escape.  Buñuel, in his 1962 film, went after the same notion in The Exterminating Angel.  His was a more satirical look—  Upper class diner party goers cannot escape their mansion and descend to their worst.

I’m not sure how much control we have anyway, but most of us had a sense that we had some control.  Much of that has been vanquished.  There are a lot of ways to react to this loss of power in our lives:  depression, anxiety, rage, insomnia, numbing by alcohol and drug use, trying to get control of others.  Some work for positive social change while others move toward spiritual, aesthetic, or intellectual pursuits.  Some garden, others build stuff.

Let’s take a look at the worst case reactions to this loss, and take a shot at possible remedies.

“We know lockdowns and quarantines are essential to suppressing COVID-19, but they can trap women with abusive partners. Over the past weeks, as the economic and social pressures and fear have grown, we have seen a horrifying surge in domestic violence.”

—United Nations Secretary-General António Guterres

The numbers of reported cases of domestic violence have risen.  I would argue this is a result of the loss of control, the loss of power.  Rape is about power, not sex.  Domestic violence is about control, not aggression.  Aggression is the means to that end.  Violence increases as one feels the loss of control.  I can’t control what is happening to me, but I can control her, which, I think, will make me feel better.  The mitigating factor in family violence is openness— other folks influence the family systems, help lower the level of tension, allow the potential ‘victim’ an out.  And now, in this time of shelter-in-place, there seems to be no escape. Hence, ‘Hell is other people.’

It comes down to how we deal with the loss of control over our lives.  One could make a case that we don’t have that much power anyway.  We just delude ourselves intro thinking we do.  Our brains make choices and we act, then think we made a conscious choice.  Or we believe we got where we did by our own hard work, forgetting parental bucks, government loans, etc.  

So on one hand we have the perception of loss of power and on the other we have the actual loss of power of economics, friendships, and sites to relieve stresses.  Add on the feeling of being trapped.  Add on the inability of the vulnerable to escape due to shelter-in-place, the concern that shelters may not be safe from the virus, and the looming loss of government revenue to support social services.   The one who has lost power has power reinforced by the limiting conditions of the vulnerable partner, child.  The children aren’t in school where a thoughtful teacher can notice and report to Child Protective Services.  

A perfect storm:

1. He feels the loss of power of having some semblance of control over his life.

2.  He believes his behavior will have no consequences.

3.  He asserts his will for control with psychological and/or violent means

4.  She and the children have no escape

5. Repeat

While, by far, most of this is gender-based, the male attacks the female, it can be the reverse and or male/male, or female/female.  We are also seeing a rise in elder abuse.  The trapped victim reactions can range from depression to suicidal ideas, from psychological numbness to physical symptoms.  No Exit.  The abuser’s psychology can range from a reasonably healthy but fragile personality to the personality disordered (narcissistic, borderline, or psychopathic).

What to do if you are under attack:

1.  Acknowledge that this is not going to change unless you take action.  

2. Find out what the resources are: a local battered women’s shelter or domestic violence hotline. 

3.  Strategize: talk with a trusted friend or family member, contact the local resources, plan an exit.

Then be prepared— if you or your children are in danger, call the police.  

The one who psychologically or physically strikes out has options, also.  In fact, they are basically the same as your partner’s: acknowledgement, find resources, strategize.  This disaster is avoidable.  There is an extremely interesting program in Mexico called ‘Gendes.’  They have had to shut done their in person services since the onset of the pandemic.  They’ve established a hot line.  Every day they get a call that begins:  “I’m calling because I don’t want to hit her.”  They are re-invisioning ‘machismo’ by supporting the positives of it (caring, protection) and inhibiting the negatives (possessiveness, controlling behavior).  You too can call a hot line.  You can read ”Why Does He Do That? Inside The Minds of Angry and Controlling Men.”  You can face your vulnerability.

Yes, there is a deadly pestilence in on our town.  Though mostly hidden, it is as awful as the pandemic.  It is violence against the trapped vulnerable.

Resources

National Domestic Violence Hotline at 1−800−799−7233 or TTY 1−800−787−3224

Every county has a domestic violence, child abuse and elder abuse hot line.

All of us have lost much control over our lives.  How does one go forward?

1.     Take it one day at a time:  The situation is fluid.  We’ve got today.  

2.    Serenity prayer: 

God, grant me the serenity to accept the things I cannot change,

courage to change the things I can, 

and wisdom to know the difference.

3.    Micro change: when faced with a new client who is overwhelmed, therapists frequently suggest looking for the smallest step one can take. 

4.   Social action:  where can you put some time, energy, cash into something postive?

5.  Gratitude:    You are alive.  A great Roman playwright, born a slave, wrote: “Where’s there is life, there is hope.”

Go easy, folks

“He who has a why to live for can bear almost any how.”

– Friedrich Nietzsche

#mentalhealth #COVID19 #psychology #meaning

The current thinking in the psychology of disaster protocols is that the question of meaning should be delayed until things settle down.  Folks are on survival mode, and following the Maslow Hierarchies of Need model, this is not the time for ‘self actualization’ thinking.  This is the time for survival.  

The World War II aphorism, ‘There are no atheists in fox holes,’ suggests that under severe stress people do consider the larger questions.  The questions of faith, spirituality, morality, and the like are our ways to search for meaning in the face of terror.  Sure, we want to survive, and will do almost anything to survive.  But the underlying question is— Survive for what purpose?  

These are not questions we may ask, or should ask.  These are questions we do and will ask.  I’d argue that we are meaning making machines.  We are hard wired to find our place in the big picture.  Most of us begin this work in our adolescence and early adulthood.  The fruits of this labor are a sense of how the world is and how we fit into it (or would like to fit into it). There is no guarantee of success in this work.  A failed identity may lead to addictions, accepting negative roles, depression and anxiety.  Being lost in the universe.  Supporting young folks finding their way through this challenge has been a deeply rewarding part of my psychotherapy practice. 

This earned sense of the world can be re-questioned at different times in the life span:  midlife crisis, a loved one’s death, trauma, or what we now face, a global pandemic.  The meaning of one’s life that had been worked on and understood suddenly does not fit with how the world is.  In that discrepancy lies the fuel for a renewed search for meaning.  

We all search for meaning, whether we want to or not.  The best approach is to do this consciously, with critical thinking, in oneself and with others.  This hard work is crucial when one’s sense of control over one’s life and the assumption of the predictability of the world has crashed.  Without that work, the path easily descends into thoughtless knee jerk reactions that can further slide into undeveloped and crude conclusions. 

Easy outs, foolish conclusions: 

1. God’s Wrath:  God sent us this disease to punish us.  A recent American example is Jerry Falwell, Sr.- “AIDS is not just God’s punishment for homosexuals, it is God’s punishment for the society that tolerates homosexuals.”  There are cancer patients who believe their disease is God’s punishment.  Sadly, research shows this approach leads to poor subsequent psychological adjustment.  

2. Blame someone, anyone, for your lack of control:  In the United States, there has been a rise in aggression against Asians and Muslims, and an increase of domestic violence cases against women.  Some countries are showing an increased  attacks on gays and lesbians.  History reveals persecution against Jews during and after plagues.  In the early 20th century, when the cotton market would crash, there was an increase in lynchings of African-Americans. 

3.  Nihilism:  If one gets stuck at the cynical-disillusionment stage of disaster response, it is easy to give up working on finding meaning.  The meaning of it becomes meaninglessness.  Here depression, isolation, anxiety, and phobias prevail.  The depressed cynic can become antisocial or even suicidal.

4.  Hedonism:  After the last great American pandemic, we had the Roaring 20’s.  Then there is the biblical response (I Kings 4:20):  “Let us eat and drink; for tomorrow we shall die.”  Here meaning is found in sensuality.  

5. Authoritarian Acceptance:  After chaos of the pandemic and the slaughter of World War I, the people of several nations chose meaning by merging with a authoritarian state.  Here there is no need to work to understand your place in the universe. You have replaced that work with a blind acceptance of an ideology.  This is both a lazy failure and psychological suicide of sorts. 

Now I suppose it would be easy to list positive outcomes from a search for meaning in this pandemic.  I could say meaning is in the realization that all of us are in this together,  e.g., as C.S.Lewis said:  “Friendship is unnecessary, like philosophy, like art… It has no survival value; rather it is one of those things that give value to survival.”  Or I could say it all comes down to kindness, like the Mark Twain quote—“Kindness is the language which the deaf can hear and the blind can see.”   Or perhaps meaning is found in the spiritual as in the Rumi quote- “These pains you feel are messengers. Listen to them.”

These are answers, someone else’s conclusions. It is far easer to accept another’s answer than asking the hard questions, and finding one’s own answer.  And there are plenty of folks out there pitching their existential conclusions, both because they want to help as well as for a quick buck. But, ultimately, I think there can be no end to this search.  It’s a daily process of living one’s life, feeling and intuition, decision making, reflection, and starting over again.  

Yes, we do need the psychological space to reflect.  It is difficult in times where  physical, social, psychological survival is at stake.  But, I would argue, it is necessarily part of the process. Traditional paths of this search include— talking with a spiritual advisor, a Twelve Step sponsor, or a therapist. Some have used their ‘gap year’ to explore meaning. Others travel to see how other cultures deal with this. Some read. Others garden. A walk in the park. For those stuck in ‘Shelter in Place,’ this down time can be an odd gift.

1. Pause.  Find a way in the midst of dealing with the chaos of getting food, teaching the children, finding work, to just simply stop.  For a second, for a minute.  For ten minutes.
2. Silence.  Let all the worries, planning, strategizing go.  There is silence underneath.
3. Reflect.  If you can, out of this silence, think and question yourself about the larger questions.  
4. Communicate.  What you are asking is deeply valuable.  By sharing in this search we all flourish.

Go easy, folks

I’ve worked with cops in psychotherapy for about 40 years. I’ve observed, and they have told me, that they travel through a series of stages in their cop career. The first is The Heroic. They see themselves as the man or woman who can help the legitimate victim, right the wrong, protect the innocent. Further down the career, after seeing unnecessary slaughter, criminal-like victims, helpless criminals, and a broken justice system, The Cynic stage emerges. Here the cop suspects the motivations of everybody. There is no joy in Mudville. The goal shifts from righting wrongs to watching the clock as one waits for retirement. I’ve seen an additional stage: The Resilient. Here the cop shifts from savior, then disgruntled to the appreciation of one’s limits and acknowledgment of the tides of human behavior.

Given classic research on stress and productivity*, work from the Substance Abuse and Mental Health Administration (SAMHA), and my contemporary clinical findings, I would like to propose a similar model for the over time psychological reactions to the global Covid-19 crisis. In this incredibly stressful time, it can be helpful, perhaps even comforting, to recognize patterns in our reactions. It’s like riding a rollercoaster. Helps to stop and gaze at the contraption before you get on. Doesn’t mean the thing won’t break and you’ll fly off into space, but at least you can see where the damn thing is supposed to go. And brace yourself for that particularly hair raising turn.

[Note: Each stage should be seen as a continuum. Like the virus itself, one may barely feel the symptoms or one may succumb to them. And everything in between.]

Alarm Stage

This phase occurred when we heard that there was a new virus in Wutan, China. There were several reactions ranging from Alfred E. Newman’s What, me worry? through Not Our Problem to running out and buying rolls of toilet paper. Our stress response to the potential disaster ranges from denial, compartmentalization to anxiety and panic. Calm reactions included thoughtful preparation. (Wish that last one would’ve been me. Oh, well….).

The Heroic Stage

Here the fear of viral contamination is overwhelmed by the psychological strength of planning and altruism. The sense of control arises as one makes plans, imagines ways to not only cope, but prevail. Work out plans are made, economic contingencies are strategized, in-home school schedule is pinned to the front of the refrigerator door. The clearer the plan, the stronger one feels. How will we get groceries? How will we exercise? Questions are answered by plans. Check on the elders, make sure the young are educated. And if possible, send a donation to a food bank. These bring a sort of calm direction. Hope mixed with anxiety energizes. Grief and loss are felt, but the survival mode is paramount. The crisis is fresh. This is coupled with fantasies of the pandemic’s conclusion: the celebration and relief of freedom from worry.

The Cynical Stage

The disaster psychology literature calls this the Disillusionment Phase. Here one just gets tired. Burned out. The relentlessness of the pandemic wears down the feeling that these are unique challenges. They become a routine without relief. At one end of the continuum is despair and at the other feelings of loss of family and friends. Grief. Getting re-energizing by friends, sports, a date night, a movie, dinner out are lost. The novelty of masks, strategizing how to keep six feet away, remembering to wash your hands, goes from novelty, to hassle to a relentless burden. Negative emotions and pettiness arise that are difficult to mitigate by the usual diversions and socializing. One realizes that all the work one has done will not bring back one’s old life style.

How does one deal with the fact that this is a global disaster with massive disruptions, hunger, economic and political instability? The idea of one’s ability to effect the situation let alone survive it is down-shifted to psychological fatigue and exhaustion. While this stage is not inevitable, without ongoing preparation for it, the potential is great.

The Resilient Stage

This is the payoff stage. Like the squirrel who buries his supplies for winter, resilience is the result of earlier work. Daily attention to ones’ body, social life, inner self can lead here. The understanding that not fretting about things that one cannot change brings serenity. This pandemic has brought us loss, grief, loss of control, anxiety, helplessness, and a ton of other difficult, but authentic, emotions. Resiliency is the acknowledgment of, and the ability to tolerate these profoundly painful feelings. With this acceptance comes the potential for renewal. This may take the form of an identity shift, prosocial activities, increased creativity and spirituality, or other forms one did not expect. And therein would be the good news.

Go easy, folks…

————————————————————————————————

* The early research on patterns of reactions to stress produced the Yerkes-Dodson Law. The idea here is that performance increases with stress, until the stress becomes overwhelming. Mounting anxiety then decreases the performance. The pattern is in the shape of a curve.

(From Francesca Gino’s article in the Harvard Business Review, ‘Are you to stressed out to be productive? Or not stressed enough?’ April 14, 2016.)

While I waited as my daughter was going through a particularly difficult surgery, I walked over to the hospital library.  I knew I couldn’t do anything for her.  It was up to the doctors.  Over the years I’ve found libraries are a good place to calm down.  A research paper was posted on an announcement cork board.  The main thing I remember about the study was that the parent’s reaction to a child’s trauma determined the severity of trauma in the child.    As hard as that time was, this common sense research greatly encouraged me.  Gave me a direction.   Calming down gives the frightened child a chance to feel safe.  And in that safety, a chance to psychologically heal.  

This pandemic is not a typical disaster.  There’s not a sudden unexpected shock like 911 or an earthquake.  Or an intense few few days followed by an ongoing crisis like hurricanes bring.  The course on this one is, as Drake sang, “It’s a marathon, not a sprint, but I still gotta win the race, yeah…” 

The 2020 Pandemic began slow as a warning, bringing a sense of threat.  This increased to schools closing,  shelter-in-place, masks, and images of nightly deaths on TV.  As parents now are home-schooling their children, the question remains about how to facilitate the child’s emotional health through this unique disaster.  Along with all the economic academic social challenges, the adult care taker must ask— how can I prevent psychological scarring and facilitate emotional resilience through this pandemic?

First, let’s look at what we are likely to see in children who are now encountering this unique and confusing threat.  The sad, but usual response to disaster, across the age span of childhood is regression.  The little ones, toddlers to kindergarten, may increase their clinging, temper tantrums, forget recently learned skills, and/or demand more attention.   Elementary school children’s regression may show up in night fears, academic inattention, behavioral problems, and/or feeling self blame and guilt.  The middle and high school kids, reacting to the shock of losing their in-person social life, may show regression via isolation,  poor home schooling progress, and, again, self blame and/or angry outbursts.  

The child with learning, psychological and/or developmental challenges brings other questions to parenting and caretaking.  Boundaries can get murky in the confusion, and again, we are faced with cognitive and emotional regression.  

Though each child is wondrously unique, there are patterns in childhood.  Understanding these can help us and decrease the potential for psychological damage.  

Things we can expect:

1. The child will watch you intently, especially your face, for clues as to what is going on.  
2. If there is no conversation about the disastrous events, in this vacuum the child will become increasingly confused, and/or blame themselves or the adults in the room.
3. If the expectations are too high, or too lax, the child will flounder in guilt, blame or self absorption.
4. If the adult ignores their own need to heal, because this is a long term challenge, the risk of burn out and emotional exhaustion is high.  

The fundamental role of parent and guardian is to protect the child.  And the most basic of this protection is physical:  sustenance, shelter, safety from attack.  Following this is protection by the support of an environment where the child’s needs for social, intellectual, psychological, creative, moral, and spiritual development can be met.  In a predictable environment, the child can grow.  In a chaotic environment the child’s survival mechanisms overwhelm all other needs creating deficits.

This pandemic challenges both the most basic protections adults must provide as well as their, our, ability to provide counsel and guidance.  It’s hard to provide leadership in this unknowable environment. This question of the parent/guardian’s ability to protect can down shift to self shame.  The challenge then is both external and internal.  External in the sense that ‘business must be taken care of.’  Food must be on the table, time boundaries must be set, expectations must be provided, play must be allowed, personality growth must be encouraged.  But on an internal level, the parent/guardian must face their own powerlessness and vulnerabilities without falling into paralyzing self recrimination.

Ways to resilient parenting:

1. Communication:  Open up a conversation.  First and foremost, listen.  What does the child think and believe about the pandemic.   What does the child feel?  Before you correct misunderstandings and false information, acknowledge what they think and feel.  Then give them age-appropriate information.  Add on the emotional support as you go.
2. Schedules:  Both over scheduling and under scheduling can be problematic.  This is the moment where the child’s unique needs come into play.  One child may need strong clear routines while the sibling may need greater flexibility.  Neither Boot Camp nor Lord of the Flies.
3. Limit the news:  This global crisis is overwhelming for us all, especially children.
4. Build the adult team:  Strategize with other parents/guardians.  The medical and social situation is fluid,  frequent check ins with other concerned adults helps us see alternatives as well as the recognition that we are all in this together.
5. Take care of yourself:  When they see a calm, relaxed adult, that emotional tone calms their fears and anxiety.  Many a child will challenge that tone to see if it is real.  
6. If the child begins to experience intense anxiety, withdrawal, outbursts, crying, etc. check in with your pediatrician or a therapist.  Telehealth works for children, too.
7. Know parenting is the hardest job in the world.  And the most important.  You don’t have to be a hero.  That goal can lead to burn out.  The challenge is not to do the perfect job, it is to show up everyday and do the best you can.  Then take a break.
8. And, most importantly, enjoy this time with your children. It’s like God said to us all—Go to Your Room!  In there we can build resentments, overwork and make our ourselves miserable.. or.. we can grow with our children, learn from them, role model the joy of learning and living.
9. Let them teach you how to play again.
10. Humor helps:  As Dr. Seuss said: ‘Everything stinks till it’s finished.’ 

Go easy, folks.

Before psychological trauma was recognized, debilitating reactions to horrible events was seen as shirking or malingering, a coward’s way of escape.  The war horrors of the Twentieth Century brought about a different understanding.  The symptoms of psychological trauma were labeled as ‘shell shock,’ ‘battle fatigue,’ and ‘war neurosis.’  Those early labels undermined the previous pejorative moral judgments.  It medicalized the experience, and allowed it to be treated.  The Vietnam War brought about increased attention to returning Vet’s painful reactions.  This scrutiny led to the current diagnosis of Post Traumatic Stress Disorder (PTSD).

Research on PTSD is extensive: the effects of 911, Afghanistan War Veterans, car accidents, cardiovascular issues, etc.  See https://www.research.va.gov/topics/ptsd.cfm . There has been extensive research on the physiological, psychological, and social aspects of PTSD.  Likewise, many treatments have been researched and are now offered ranging from Psychodynamic, Acceptance and Commitment Therapy (ACT) to Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) therapy.  The research on the effectiveness of these shows mostly positive results.  Generally, I have found that if the practitioner shows care, consistency and respect, healing follows. 

It doesn’t take a crystal ball to predict that there will be traumatic reactions to this pandemic:  Invisible threat.  Death rates increasing.  Forced familiarity with family and/or roommates.   Physical distancing nationally enforced.  Inability to enjoy one’s usual pastimes.  The challenge of home schooling.  And all too frequently, the inability to make enough money to provide sufficient food for the family. 

Biologically, we are wired up to deal with stress.  One may go the route of Fight— The bully gets punched in the nose.  Or one may go the route of Flight— the gazelle flees the lion.  In recent years researchers have added Freeze as a response.  The predator appears and one freezes in the hope of not being seen.   In the short term, these responses are adaptive and can lead to survival.  The problems arise when the Fight/Flight/Freeze reactions continue on after the threat has passed.  The remote is stuck on one channel.  This pandemic is forcing us all into a Freeze response.

While we can’t know yet the psychological damage this pandemic may bring about, we can plot ways to avoid post pandemic trauma.  ‘Avoid’ may be too strong of a word here.  How about mitigate?  There are steps to lessen the psychological scars that will follow from this global crisis.  There are ways to build resilience.  First the bad news:

Ways to increase trauma potential

1. Drinking in excess, while briefly numbing, will lock the trauma into place.  Same with drugs.
2. 24/7 news watching may feel like staying on top of coping strategies.  In fact, it sends the neurological alert systems on overdrive.
3. Isolate and withdraw: while it may seem safer to keep away from everybody, we need the interaction to heal.
4. Argue/rage:  when a situation, like this one, brings about feelings of helplessness, we can feel more in control if we blame the ones closest to us.  Scapegoating never leads to healing.
5. Self blame: likewise, scapegoating the self creates so much internal static that we can’t calmly face the future.
6. Indifference as a way of dealing with this challenging and deadly pandemic leads to numbness.  And numbness is one of the hallmarks of PTSD.
7. Vicarious traumatization can be the wound of the empathetic helper.  This is a major danger for First Responders and caring professionals.  Frequently leading to burn out, it can create psychological paralysis.
8. To deny our emotional reactions in the midst of ongoing fear, vulnerability and grief may seem safer, but the lasting impact again can be numbness and PTSD.
9. Acting out against our vulnerability by challenging the common sense public health requirements may being a brief sense of being in control, but it can also lead to both physiological and psychological damage.
10. Worry, worry, worry-  Anxiety and rumination tends to reinforce itself creating more worry.

Ways to build resilience (daily practice):

1. Social support:  If there’s one thing I’d recommend above all others, it’s having a trusted buddy.  He/she can share the pain, confusion, strategies, and hopes.  Usually it’s better to have a couple, or even several.  No one person, partner, spouse, friend can do it all.  
2. Physical activity:  Getting stuck on the ‘Freeze Channel’ backs up the stress hormones which can lead to cardiovascular damage as well as an inability to psychologically heal.  Keep active.  Everyday!
3. Mindfulness:  There has been a lot written about this practice recently.  There are plenty of apps.  See https://psych.ucsf.edu/coronavirus/apps
4. Creativity:  Creativity by definition facilitates changing mindsets.  And this then adds to our ability to change from a pre PTSD approach to more of a resilient mind set.
5. Self compassion: given the entire world is going through a bit of hell, this is a great time to cut yourself some slack.  You don’t have to be the perfect home teacher, the great wage earner.
6. Spiritual approaches:  though we can’t attend our places of worship right now, we can pray, meditate, talk with our spiritual guides, our AA sponsors.
7. Acknowledge hard emotions:  Both fear and shame are foundations of PTSD.  They are natural reactions to this global crisis.  By not denying these and the ability to build a tolerance for these unpleasant emotions now, we don’t have to get process them later.  
8. Acknowledge our limitations: The Serenity Prayer sums it up:  God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference.  This saying is common now in AA and other 12 step programs was written by Reinhold Niebuhr and has its roots in Classical Stoicism.  
9. Help out:  Those who pitch in to help do better both in the short and long run. These contributions can range from an economic donation to helping making masks, to bringing food to the elderly.  Do it for others thereby you do it for yourself.
10. Humor:  As W.C. Fields said, “There comes a time in the affairs of man when he must take the bull by the tail and face the situation.”

Go easy, folks

There’s a lot of theories of psychology.  If I tried it enumerate them, the list would  long.  The one that comes to mind when looking at folks’ reaction to this pandemic, including my own, is attachment theory.  See John Bowlby, Mary Ainsworth, and others.

This approach suggests there are different ways we attach to loved ones early on, and then how we relate to the social world as we grow older.  These patterns of behavior are broken into four approaches: Secure, Avoidant, Anxious/Ambivalent, and Unresolved/Disorganized.

Let’s see how these might line up with one’s relationship to the Covid-19 pandemic, especially in terms of living with the unknown, ‘shelter in place,’ and mortality.

Secure:  I am not easily frightened, am not particularly worried about being abandoned or fearful in matters of intimacy.  In chaotic and frightening situations, one can expect a reasonably resilient response.  Of course, this person can become upset, but there is shorter recovery time.  The deep enclosure of quarantine and mandated social distance from some and in house physical intimacy with others are problematic, but the problem solving skills of the securely attached come to the fore.  This is an autonomous reaction.

Avoidant: I am nervous in close contact with others, I don’t like to trust others, and I really really don’t like to depend on others.  The avoidant’s response is to be dismissive.  Each new situation for the avoidant becomes a challenge to maintain independence and self reliance.  Because this pandemic has so many unknowns and has jammed roommates, friends, and family members into close quarters, the style’s response would be to retreat and be dismissive of the dangers and seriousness of this pandemic.  This retreat would look like isolating and/or anger if pushed to interact.  In response to the pandemic, their avoidance could lead them into a “Minimizer” approach.  

Anxious: The anxiously attached are preoccupied with their relationships.  Constantly worried about the stability of my social world, I anxiously want social contact and reassurance, and am disappointed and hurt if that reassurance does not arrive.  This attachment style would feel highly pained that we are now mandated to have ‘Social Distance.’  Here, anxiety and preoccupation would be the key themes— worry about family, friends, the world.   Of course, one must be concerned about these, but to be effective in this global crisis, it is crucial to recover from the worry and be able to manage the problems.   In response to the pandemic, this anxiety could lead them into a “Maximizer” way of coping.

Unresolved/Disorganized:  Typically, this attachment style is a result of trauma and chaos.  Here there are tremendous swings of sense of identity, intense inner chaos, and extremes in differing responses to the world.  Coerced quarantine and the lack of safety would suggest a fair amount of disruptive actions for this person and some amount of distress for those in close proximity to them.

These attachment styles are vastly general, but they are a way to think through our own reactions to this rapidly changing and frightening world.  They can also be signposts for healing change.   More about that next time.

Go easy, folks.

Medical Personnel, Cops, and Firefighters know how to steel themselves against their natural feelings.  They have to.  Who else would touch someone with a disease that could kill you and your loved ones?  Run into a fire when everybody else is running the other way? Run toward gun shots?   This ability to hyper focus on the task at hand is both a gift and a curse.  The gift side of it allows for the rest of us to live a reasonably secure life.  The gift side of it allows the cop to wrestle down an inflamed meth addict before he attacks a citizen.  This is the job.  These well trained first responders live in a complicated world.  The downside, the curse if you will, is it takes a toll on the body, the psyche, the social life, and the family.  

The ongoing stress of the job blows up in times of community crisis— long hours, separation from loved ones, an inability to ‘let go’, to work out, to joke around with the dark humor that makes the job easier.  I saw this in the 1989 Loma Prieta  Earthquake.  Some of the debriefings showed that much of the stress first responders felt was the inability to connect with their families.  All of this is exacerbated by the loss of sleep, the continual facing of a situation that seems out of control, inability to have a regular meal, and the frequent upper administration flubs.  

Based on that experience and 40 years of clinical work with first responders, here are a few thoughts on first responder psychological survival in this time of Covid-19.

Ten things that will get you in trouble:

1. Lots of coffee to rev up; lots of booze to calm down.
2. 24/7 on top of the news
3. Anger at the family and friends that they ‘don’t get it.’ (Don’t understand the seriousness of the pandemic, or massively overreact to it.)
4. Impatience and then pulling back from family and friends.
5. Random sexual activities.
6. Stopping the workouts.
7. Eating everything in the room; eating nothing in the room.
8. Taking on lots of extra duties.
9. Ignoring your body.
10. Not reaching out.

Ten things that will help:

1. Work out.  
2. Reach out.  
3. Cut the family some slack.  Takes civilians a while to catch up.
4. Stop and check out what’s going on with your body.
5. Take a break from the news.
6. Pray, meditate, or simply breath— deeply and slowly.
7. If you start to get into trouble (exhaustion, numbness, insomnia, feeling other’s trauma is yours), connect with your close friends, peer support folks, or your organization’s stress unit.
8. Work with your family and/or friends to create a strategy for the worst case scenario, then let go.  
9. Remember your supervisors are stressed and confused like everybody else.  Keep your expectations low.  Be clear on your boundaries and role, but, paradoxically, add creativity to the work.
10. Most importantly, remember that you can’t take care of anyone else unless you take care of yourself.

Go easy, folks