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Cristina Fiorani, Sara Guidotti, Marisa Poggioli, Piero Verani, 2020. Italian chronicles of the Covid-19 pandemic Lived reflections on our unequal world and our precariousness in the face of Anthony Ryle’s egalitarian values.. Reformulation, Summer, pp.5-9.
Suddenly the virus was amongst us. Now we are confined indoors, no longer free to live and plan.
Thinking is hard as we wonder: “when is it going to end?” It’s hard. We live in fear and yet look at the clear skies; no planes, no smog. CO2 emissions are going down. We can hear bird song. The rich amongst us, with more space, can survive this better, maybe look upon it as a time of retreat, although we are all fearful of loss. We embarked on thinking about the inequality of our human world, informed by Anthony Ryle’s egalitarian values.
Piero, a psychotherapist, who lives near where the ambulances pass on the ring road
It is as if we are / on the beach / waiting for / the tsunami.
This condition concerns those of us who do not have the specific CoVid-19 virus (or being asymptomatic, believe they do not have), but around them they see and hear many more ambulances than usual; finding that acquaintances or friends are infected. We read or listen to the media talking about the intensifying epidemic.
Paraphrasing a poem by Giuseppe Ungaretti
It is like / autumn / tree / leaves
We feel as leaves approaching autumn. Equally, it seems like a war. Soldati (Soldiers) is the title of his poem, which he wrote in the forest of Courton, France, in July 1918 towards the end of the First World War: soldiers and leaves both live temporal lives, witnessing both a precariousness and the awareness of the precariousness of the passing of human life. We are like the leaves and not, as we have long thought, the trunk with the roots connected firmly into solid ground.
On 20th February 2020 in Codogno, Lombardy, near to Milan the first case was identified. We are in Piacenza, Emilia-Romagna and only 10 kilometres from Codogno. Very soon we saw the health system overwhelmed and tents outside the hospital were set up and took root – sprouted - as life and leaves fell, to isolate the suspected positive cases. Patients were diverted to distant hospitals: a different kind of branching out. In the worst days of the epidemic we exceeded 30 deaths from CoVid-19 in a single day, too many for a provincial city and within 24 hours we counted over 160 busy ambulances, an average of one approximately every 10 minutes replacing our busy lives.
We lived - or survived rather - a succession of conflicting myriad emotions as the epidemic developed. We were amazed; we trivialised it; we underestimated; we lived in fear. There was rejection, denial, panic, anguish, anger and indifference. Some were mourning loss and others appeared detached and did not seem to care. Social media slogans - later taken up by the media - #milanononsiferma /#piacenzanonsiferma (#milanodoesnotstop/ #piacenzadoesnotstop) feared another kind of loss: that of economic loss. These voices of denial about the gravity of the situation embody the panic and terror of life-having-to-stop.
Italy became the red zone: we needed protection; we closed everything except essential food and medical supplies. Some people were irresponsible: not just the young. Some of the elderly did not accept the restrictions, rebelling with their idea that "with the little life left in me, I don't want to be at home shut in". Perhaps they are not able to exploit digital technologies which allow us to make up for the loss of life encounters. Others with mental health challenges or with other underlying medical organic conditions - grasp the seriousness lightly. Other short-sighted entrepreneurs focused only on economic aspects, devaluing the human condition; in their push to end the #lockdown to help the economy.
The global pandemic (the damage it causes and the attempts to stem it) have caused a violent psychological earthquake. We have been catapulted into a condition of impotence and passivity. It makes me think of Friedrich Nietzsche who speaks of the eternal return in terms of cyclical time in The Joyful Wisdom (1882):
“This life, as you now live it and have lived it, you will have to live it again and again countless times, there will never be anything new in it, but every pain and every pleasure and every thought and sigh, and every unspeakably small and big thing in your life will return to you, all in the same sequence and succession - and so also this spider and the moonlight among the branches and also this moment and myself. The eternal hourglass of existence is always turned upside down again and you with it, a speck of dust!”
Furthermore, the health crisis has called into question a very Italian stereotype concerning health. Today everyone seems convinced that it is important to support public health, which has been decisive in tackling the CoVid-19. But until yesterday many people despised health care facilities and healthcare staff in favour of private ones. And tomorrow who knows?
Cristina has been in social isolation as a precaution. With filter mask donned, she speaks to patients online.
I currently work as a psychotherapist, for the Italian state health system in a child and adolescent unit. I have always been passionate about my work. I felt safe in my job where I have worked for the past 30 years and have often voiced limitations of the system, working in fidelity to my role. Italy is made up of state workers, like me; others who own their own businesses large or small and the precariat class, often at tension with one another. Pre-Covid-19, Italians who capitalise on private earnings, often accuse state workers of deriving a wage on a free ride. The precariat class is one of the first to suffer in such a downturn and many used to immigrate. Now my country is in dire economic straits I wonder what of my future? A fleeting thought, I was also wondering about retiring, now swallowed up in a moment of insecurity as I feel threatened not only with illness but with what I have taken for granted. Will this too be taken from me? I ask myself about the social dimensions of the virus.
Is it democratic? Does it treat everyone the same? Does the virus affect different people depending on their social status?
The hashtag #stayathome is surely lived very differently if you live in 40 square metres without a garden; sharing that space with several people, children, maybe you do not even have a balcony. Some live in a big villa with a garden the size of a park. We are all in #lockdown but how much space you have around you makes a lot of difference. We live in a reality shaped like a pyramid where 1% of the population lives in a luxury apartment with optional country villa. The majority has very little personal space; the media keeps repeating that we are all in the same boat but actually it is not quite like that. We are in different boats. Older people are dying in care homes where less health governance rules; staff are less regulated for regulation costs money! So the residents have been vulnerable to contagion. In the news everyone with a mouth, speaks without qualification. Scientific literacy – the inability to read and write divides the social classes. The more educated are able to defend themselves more and are aware of source reliability issues. What of the others? We keep asking the same questions and we want the answers: how long will it last? How many have died? Where did it come from and whose fault is it?
The answers multiply and seem to spread out like an open fan. There are a wide spectrum of answers from pseudo-science, to anecdotal evidence, to information chaos and then disinformation. We are looking for a collective “we” as our fallen reality resuscitates a yearning and feeling for connecting with a jointly shared and formulated goal: a common understanding across the divisions of our community.
With the precariousness of viral alienation of Self from Other: we are in danger of more distancing from one another; physical and proximally with the antiseptic gloves, masks, which sterilise our human appearance. Even now as we enter the age of internet streaming; work; play, even the sacred Mass of the Catholic Church - is distanced.
What will we remember from these days? Maybe we will learn. Maybe nothing will change and maybe we will find ourselves again in a similar emergency?
Marisa from afar: thinking about where part of my heart is.
I am writing this with my Italian colleagues, from London England where I am based. I work from home as a bank psychologist for the NHS. Indeed, I feel very far from home. We hope that those in public office will help and guide us. We place our hopes in our politicians to rescue us. I think of the sudden turnaround from austerity; the past 10 years of budget cuts which have decimated our health and social services. Austerity now seems to have been abandoned in all alacrity. There are also voices which surface closer to home; saying that the solution is worse than the virus as we are sacrificing the young for the old, damaging the economy.
Powerful words: virus; infection; contagion, paralysing. Until very recently I experienced the vicarious thrill of these words through the media. From a safe distance I remember watching a documentary about the Spanish ‘Flu; or films such as Pandemic. Fight and flight from a safe distance living it though the experience of the survivors and a happy ending. It was happening to them, not us. A story of infection on a screen that I could forget at the flick of switch. Not now: it touches us all. I have always believed in Anthony Ryle’s message that mutual respect and interdependence is desirable and achievable even at the level of society, Ryle, A. 1995). Indeed, a just world is desirable in terms of health for both humans and the environment. Being sociable, connected and respectful to each other makes us feel safe. It is our biological imperative and not that we ought to be nice as an ideology but rather informed by neuroscience which supports this equilibrium as the real issue for social interactions are actually using the same neural pathways that support health, growth and restoration, Porges, S. (2017). In essence we need to feel safe before we can heal.
“For too long psychoanalysis and CBT have located the causes of individual distress in the mind of the suffering individual.” Lloyd, J. and Pollard, R. (2019).
I am aware of a split inside of me when I practice my profession within the NHS. I know as Anthony Ryle did that social, economic and political issues have an effect on mental distress and I consider myself a good enough human being. I want to help my patients have a better outcome. Since becoming a therapist some 30 years ago I feel I am being forcibly channelled into adopting the traditional assumption that client’s levels of anxieties or resiliences are at fault. We are supposed to increase their window of tolerance and do all the therapy work inside their head. In contrast, CAT sees how reactive the individual is, to his environment, captured through reciprocal roles. We are also tacitly encouraged by other conceptual models to lose sight of Ryle’s environmental context. Far from it, CAT has always kept me connected in dialogue with the environment as a person within the environment. Slowly the world inches along a paradigm shift away from an unreflected primitive Cartesian split of mind vs body yet alas! Our politicians are not so informed! Theirs is the failure of planning for health services.
When I studied for my psychology degree it was within the context of a faculty of Social Sciences. The first book that I was given to read was a book on Inequality. It begged the question as to how inequalities arises. Who has the power; who is the perpetrator, who are the powerless? Are there victims? “All societies have two essential needs – meaning and security” and all societies so far express some form of inequality, Pikkety, T. (2020). We live in a period of increasing inequality: the views of the governments of the UK and the USA imply naïve trust in market forces thus the widening chasm of inequality across the health sector.
Pandemics do much to break down our beliefs in a just world, shattering the hope that there is a benevolent someone looking down and protecting us. We fear that the people who should be looking after us are uncaring and that we will be abandoned. We fear that this virus will affect us differentially according to social differences, leaving some helpless and vulnerably exposed whilst others will be more able to protect themselves as “the right for everyone suffering from mental distress to have access to effective dynamically informed relational therapy in the NHS”, Lloyd, J. and Pollard, R (2019) has been severely compromised. This virus has placed us all in a fight/flight dilemma lowering our immune response.
Communalism – being alongside one another – may decide how we navigate towards our own future survival. I have noticed the growing community spirit in my streets; a sense that we are all in this together. Would Anthony Ryle be proud of the social support mutual respect and interdependence that we have developed via WhatsApp social media? I hope that this happens everywhere. I hope that this virus makes us think about how we want to live rather than how rich or endowed on social media we can become. We now have the neuroscientific foundations confirming Ryle’s egalitarian model and as a body of therapists with a coherence of theory of human development in society we hold the cognitive and analytic tools to speak out against political injustice, grounded in our mapping skills and observation of societal reciprocal roles in the service for the common and greater good.
Sara – in mid training, partly qualified, at home feeling isolated
One day, there I was there excited about my plans and, my future. Just a day has gone by and now I am in lockdown at home, eyes on the television, which feels like the only window open to me to try to glimpse and understand what has been happening outside. The health emergency from CoVid-19 abruptly interrupted the continuity and certainty of our lives. For those who have to work and are subjected to pressing occupational routine and rhythms and risk their lives, to others who all of a sudden are in lockdown at home and compliant with the restrictions implemented by government. For some, the fear has been of contagion and health problems for self and family. For others and me, the anxiety was derived exclusively from the news.
I think of texts I have been studying on how physiological activation influences cognitive processes: how arousal narrows the attentional focus thus promoting the processing and assimilation of restricted data sets; mostly congruent with the stimulus that determined the arousal. I see myself experiencing this now. It is something I was going to teach my clients, yet now I observe the same within myself. I hear the sound of ambulances: it makes me even more nervous. I think about how the stories on the news preoccupy and prevent our attention and focus from shifting.
I feel trapped.
The feeling at this moment is that of being paralyzed; suspended; helpless; useless; waiting for those who lead (in government) and the one who commandeers us (the virus) to decide our fate or unfreeze us. I want to have the positive feelings I so recently held, such as the excitement and anticipation of the future and projects that I had been working on. These have all been put on hold. I yearn for a return to normal but the news inevitably feeds my anxiety and fear.
Maybe healthcare personnel feel powerless in the face of this invisible enemy too. These feelings in the face of the unknown, frightens us and we feel vulnerable. It reminds us over and over again we are not the masters in control of our lives. In fact, we often think that someone should be in control of the situation and perhaps this reassures us: the conspiracy hypotheses make us believe that at least ‘someone had plotted it’ or ‘someone has the situation under control’.
Neuroscience reveals the individual uses two dominant neural pathways to process reality. Psychosocial stressors are processed by way of the amygdala, which characterizes McLean's reptilian brain of the tripartite brain structure, and allows a rapid but coarse processing, responsible for the emotion of fear and imminent activation of fight/flight behaviour. McLean’s neocortex forms the second cortical pathway, which allows for a more accurate and sophisticated processing: it is responsible for the cognitive processes that allow for reflection, understanding and modulation of emotional activation and constructs meanings however requires time to reflect as well as the resources to undertake, LeDoux J. (2000). All of this is predicated on social support, for the regulation of emotions is mediated by the intersubjective space and context. Now that this pathway is impaired through social distancing and virus alienating relationships, we must turn to technology, where it is possible to simulate proximity. We can still connect online and stay in touch with those who contain us and enable is to feel safe and held, carrying the burden of our lived loss and connecting in solidarity as one desperate human to another.
As quarantine goes on, moments of reflection free us from our hectic and unreflecting former lives, enabling us to see our own life as if from an outsider’s eyes. The loss of human life is great but Covid-19 cannot take away the act of reflection grounded in the essential elements of human life: relating. I see this moment of noticing my own Self-Self state reactions to anxiety/ uncertainty and now I hope that I can reach out to others - to support them as a generous act of - belonging to this community.
Concluding Reflections
In the face of Covid-19 we are faced with a dilemma: Either everything remains as it is, with rising inequality, or we are able to change, thinking and holding the well-being of our planet for the common good. To change even slowly towards a sustainable, ecological and protective economy, that is to say, a relational economy, would be a step towards a better future.
We anticipate a different post-CoVid-19 economy, because the virus has forced a change in international relations and has destabilized social relations.
The social injustice exacerbated by the health crisis is undeniable and differential for access to resources. Fears, uncertainties, traumatic experiences and social distancing expose the individual and the community to further dissociations and fragmentations (Self to Self, Self to Others, Others to Others). Neural networks of social engagement are activated when we find ourselves in a situation of relaxed safety. In contrast, these are deactivated in this dissociated survival mode, for in defensive states, it will be difficult for us to detect cues of safety, Porges, S. (2017). Yet hope remains: relating - social relations - also activates our neuro-social engagement system.
With CAT we already have the disposition and tools to become an important voice in promoting Ryle’s egalitarian and relational model in this current uncertainty towards a new politics of health equality for the common and greater good.
References:
Ledoux, J. (2000) - Emotion circuits in the brain. Annual Review of Neuroscience, 23: pp155-84
Lloyd J & Pollard R. (2019) - Cognitive Analytic Therapy and the Politics of Mental Health, Routledge pp 1-7
Piketty, T. (2020) Capital and Ideology (translated by Arthur Goldhammer) The Belknap Press of Harvard University Press, Cambridge Massachusetts, London England
Porges S. W. (2017) - The pocket guide to The Polyvagal Theory: the transformative power of feeling safe. W.W. Norton & Company, p100 Piketty T. (2020). - Capital and Ideology. Belknap Press, pp59
Ryle A. & Kerr I. B. (2020) - Introducing cognitive analytic therapy. Principles and practice of a relational approach to mental health. 2nd edition. Wiley Press
Ryle A. & Kerr I. B. (2004). Terapia cognitivo-analitica. Teoria e pratica. Editori Laterza
Wilkinson R. & Pickett K. (2018). The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity and Improve Everyone’s Well-being. Allen Lane
Correspondence/further background reading references available: Tolstoy@libero.it