Relationships During Times of Stress- III

I’ve mixed feelings about the idea of ‘stages’ in psychology.  A whole world seemed to open up when Elisabeth Kübler-Ross presented her book- On Death and Dying.  At last a road map on the pain around death.  She postulated a five stages of grief model: Denial; Anger; Bargaining; Depression; Acceptance.  The thing became so popular it was a adopted as a framework in a movie about the choreographer, Bob Fosse (All That Jazz, 1979).  Even though I liked the guideposts, I had doubts.  They didn’t seem to match up with my experience around my father’s death when I was twelve.  All I remember was a long tunnel filled with a dark fog.  And from there, those five, in no particular order, and a few more…Then, of course, I felt some shame that my grief didn’t match up with the way I was supposed to feel things.

The argument about the power of cycles and stages is a big deal in Western philosophy, goes back to Classical Greece.*

In the first essay on the Pandemic I spoke of the stages of a community response to a natural disaster—Shock, Heroic, Honeymoon, Disillusionment. Right now, I’m trying to figure out where we are. And, figure where I am on the individual’s reaction to stress stages—Alarm, Resistance, Exhaustion.  There is also the stages of a First Responder’s career— Heroic, Cynical, Resilient.  These all seem pretty close to how it works, but they are not necessarily sequential.  They are not for everybody.  Gender, culture, class, and many other things play into this.  We are not locked into these sequential stages. 

In the discussion on roles, I ended up with— there are powerful pulls toward being a certain way (genetic, class, culture, history), they might even go from the possible to the probable, but they are not mandated.

Given the urgency of the pandemic and the social crisis, many families have had to re-form themselves without the outlet of schools, friends, couple date nights, etc.  First responders, work groups, and roommates the same.  This creates increased intensity. Pressure cooker city. There will be meltdowns.

So let’s take a look at Stages of Group Developement in this time of Covid and social crisis.  Again, these are ‘tendencies,’ not absolutes.

 The classic social psychology work on group development suggests several stages:  Forming, Storming, Norming, Performing, and Adjourning.  In each stage, various roles come into play such as Leader, Follower; Counter-dependent, Dependent, Independent, etc. 

Group Stages:

Forming:  Folks are unclear on what the goals are, what the roles are, who are the leaders, what the boundaries are.  There can be poor morale, poor listening, and low commitment.

Storming: Emotions that were disregarded at the beginning surface.  Arguments about boundaries, leadership, and power are abundant.    Cohesion and consistency are low while anger, resentments, and power struggles ascendant.

Norming: coming out of the conflict of the Storming Phase, members move toward ‘rules of the road.’  This is the way we do things.  Folks increasingly listen to and take each other into consideration.  Leadership issues, while not necessarily solved, are calmed.  Assertiveness is rewarded.

Performing:  After the earlier struggles, Folks relax into taking care of business.  Tasks tend to be less fraught with power issues.  There is increased creativity, openness, flexibility and pride in the group. 

Adjourning: The crisis looses its urgency and the intensity of the pandemic and social /cultural crisis decreases, folks return to the world.  Here there is a sense of loss, and hopefully, a sense of respect for their history together as well as respect for lessons learned.

There is a great hope in both role and group development models.  The roles we have become attached to are in fact flexible and can be dropped like a three day old halibut.   What seems like an intractable unproductive family, work group, is best seen as a thing in transition.  It is helpful to name the stage. This is especially true now in this time of monumental global change.

So today, I’d say I am in the Disillusioned, Exhausted, Group Storming stage, with a touch of Acceptance. Mañana? I’m planning on the Group Performing and Resilience Stages. We’ll see…

We are not stuck. This may be good time to take a look at the role you play, the stage your family, roommates, work group might be in.  Where do you want it to go?  What role do you want to play?  What do you need?

Step back and take a look.

Go easy, folks.


* In Western philosophy, the argument about stages goes back to Plato.  He theorized there were several forms of societies that evolved from each other, tyranny, meritocracy, democracy, etc., ending in rule by the Philosopher King (presumably him and his buddies).  That stage idea went even further in the cycles of history theories of Giambatistta Vico (Theocratic->Aristocratic->Democratic, then Chaos leading back to the first). Karl Marx’s stages of society ends in a classless and free society.  Sure, right. Arguments against these political deterministic cycles of history were led by Karl Popper (The Open Society and Its Enemies).   Camus also weighed in for freedom from stages in his arguments with Sartre about Marxism. 

I guess I am with that great Marxist, Groucho, who proclaimed— “Be open minded, but not so open minded that your brains fall out.”

Moral Injury and Morale in the Pandemic

We all have standards by which we live our lives.  Some say we blindly accept those passed down by our families and friends.  I’d argue most of us question the passed down standards as we grow up.  Starts at two years old or so.  The advent of that great word ‘No.’  Or even “Noooo…” coupled with a high pitched whine.  Drives parents nuts.  This is the first step towards the un-acceptance of received authority, the beginning of a separate individual, separate from parents.  Unpleasant process, but crucial.  ‘Me’ based on denial of your authority.

The Western tradition begins with with disobedience.  The first story in the Bible, Adam and Eve eat the forbidden apple.  From there on out they have to put clothes on and act civilized.  In the Greek origin myths, Prometheus disobeys Zeus to bring fire to humanity.  His punishment is to have his liver eaten out by an eagle.  Daily.  Forever.  Though there are plenty of stories of the acceptance of the prevailing rule, (Abraham prepares to sacrifice his son, Isaac; Agamemnon sacrifices his daughter, Iphigenia), the rebellion against received rule set up the origins of Western society.  

After the horrors of the Twentieth Century’s violence, psychology began to study how  blind acceptance of authoritarianism works:  ‘The Authoritarian Personality,’ the Milgrim Studies, the Zimabardo prison study.*  As an early college student, I first became fascinated by psychology when I read the Milgrim experiments.  Certainly fed my 60’s rebellious nature.

Later in life I was taken with the Greek Oxi Day.  Oxi, (οχι) pronounced ohi, means ‘no’ in Greek.  When Mussolini requested Greece to allow his troops to enter Greece, the prime minister denied him.  There were demonstrations in Athens where people shouted “oxi!” This is celebrated in Greece every October 28.  Oxi Day.  Greece paid the price for their ‘oxi’ by Fascist brutality.  Ultimately Churchill said about their defense:  “Hence we will not say that Greeks fight like heroes, but that heroes fight like Greeks.”

There is something compelling about a big fat oxi.  No!  I will not accept your authority over me.

But how do you say no to a pandemic?  I guess the moral choice here is— “No, I will not become one of the ill, hurt myself, my family, and overload the hospital beds.  I will stay home.”  Yet, in the wider world, there are those who have lost their jobs, health care coverage, have children to feed with no income.   What is the moral choice for them?  And the others, those who automatically say no to Public Health concerns because of their political viewpoint?

It would be nice if the moral issues in the pandemic were simple.  Virus evil, us good.  Yet, even with all the pain and suffering, now you can see blue skies above Beijing and Mumbai.  It’s complicated.

A morality based on ‘no’ is insufficient.  It does not build into a prevailing life code that includes care for others, building positivity, creating a caring community.  Plus, neurological research suggests we are hardwired for empathy. “The ventromedial prefrontal cortex processes feelings of empathy, shame, compassion and guilt. Damage to this part of the brain, which occupies a small region in the forehead, causes a diminished capacity for social emotions but leaves logical reasoning intact” according to an article on the research (LA Times, 3/22/2007).

Much of my clinical work has been working with those suffering from Post Traumatic Stress Disorder (PTSD).  In this pandemic, I’ve written on methods to prevent PTSD.  Though the concept of PTSD facilitated a clearer understanding of what psychologically injured folks are going through, it can miss a subtle, but crucial variable— the moral dimension.

Moral distress, moral injury, and moral repair.

Beginning in the 1990’s, writers and researchers have added the moral aspects to the understanding of trauma.  While the current treatment approaches to PTSD are mostly effective, they do not work with everybody. In fact, research now suggests that work with PTSD for some that does not include the moral dimension may be deleterious.  Further, in early neurobiological research, one can see the differences between PTSD and a moral injury in brain scans.

Moral Distress occurs when one knows the moral action to take, but feels powerless to take that action.   Taking that action may be limited by the internal (fear, doubt) or the external (no clear effective approach, failure of leadership).  Here is what one believe one should do, but can’t. Moral Injury is characterized as the result of being forced to engage in actions contrary to one’s moral values; a violation of what each of us considers right or wrong.  

These are wounds that are derived from damage to a person’s moral foundation.  These moral crises are not based on fear as is PTSD.  One of the tools psychotherapists use to treat PTSD is exposure therapy— easing one into remembering the traumatic event to decrease the emotional storm.  For the morally injured, this brings no relief, and can intensify the pain…and shame.

In this pandemic, we are all in a perpetual state of moral distress.  We see the mounting death toll among the elderly, the weak, the wounded, the poor. We may be at risk ourselves.  We may be on economic survival mode.  We may not be able to see a clear path to help.  So we are stuck.  

Hence, moral distress.  And moral distress over time can lead to moral injury. 

According to a VA report: “Guilt, shame, and betrayal are hallmark reactions of moral injury. Guilt involves feeling distress and remorse regarding the morally injurious event (e.g., “I did something bad.”). Shame is when the belief about the event generalizes to the whole self (e.g., “I am bad because of what I did.”). Betrayal can occur when someone observes trusted peers or leaders act against values and can lead to anger and a reduced sense of confidence and trust.“

The idea of stages of psychological reaction to this pandemic includes the cynical/disillusion stage.  Here is where folks may experience depression, burn out, exhaustion.  A part of this may include ongoing moral distress moving toward moral injury.  The cognitive dissonance between what we feel we should do and what we actually do eventually overwhelms.  Our morale drops.  

Let’s talk about moral repair and resilience in a later time.  But the initial steps to sort through the moral issues here are yet again the same as dealing with the power issues: Acknowledgement, resources, strategize.

 1. Acknowledgement:  look at what you are doing and feeling.  Over watching the news and feeling anxious; avoiding all the news and feeling empty; physical symptoms can include GI issues, insomnia, headaches, nightmares.  Is there guilt? Shame?

2. Resources: Imagine what you would like to be able to do and yet can’t, or won’t. Then think it out… talk to a friend, spiritual leader, 12 step sponsor, a therapist.

3. Strategize: Be clear on what you can do and cannot do.  Note what you have been able to do.  Then consider what may be possible: donations, checking on a neighbor, nodding to a passerby on the street.  And underlying all of this— be kind to yourself… and others.. if you can.

Go easy, folks.


‘The Authoritarian Personality,’ the Milgrim Studies, the Zimabardo prison study: