By Jerry Fromm, PhD, 4x4@4:00 “Talking It Through” moderator   

The theme of this fourth and final 4x4@4:00 “Talking It Through” session was disruption/re-thinking. The number of disruptions mentioned was striking, and many of them require us to re-think things we have “taken for granted.” For example, a stimulus check, designed to help people through the economic consequences of the COVID-19 crisis, opens up for some people a craving for substances that had been tenuously held in check. Or a family that is spread out during the work day is suddenly confined to a small space, leading to eruptions of anger, even to domestic violence. Or a child normally at school sees TV images of police brutality and is traumatized. Or a support group functioning well over a period of time is suddenly out of touch because basic survival needs come first and because members have no access to computers or the internet. The shift to Zoom that most of us have taken for granted isn’t available to them. One first reaction to this is “Who knew!” and a second is “How did we not know?” 

COVID-19 has made visible and, in one panelist’s words, “magnified” the disparities that have been there all along, and the vulnerabilities as well. The risk factors for suicide–isolation, unemployment, substance abuse, the presence of guns in the house, and so on–are all up, but fortunately so are the calls for help and so is general attention to mental health. In last week’s conversation, “deaths of despair” were mentioned; this week too, those seem like a major risk in the coronavirus context, though no statistics are available yet to assess that. But the protests that have erupted following the murder of George Floyd two weeks ago hint at a different possibility. “Deaths of despair” have been interpreted to mean that a vulnerable group of people feels expendable in today’s world: that they don’t have the resources–including the emotional resources–to join society and the latter seems happy to go on without them. The protests suggest a serious push-back on this quietly held status quo: that Black Lives Matter, and that at least this vulnerable group will no longer be seen as expendable by themselves or by the many who have joined them.   

The risk factors for suicide–isolation, unemployment, substance abuse, the presence of guns in the house, and so on–are all up during COVID-19.

One participant said she sees “a new urgency to reckon with” things in her work with patients, particularly where patient and therapist are of different races. That phrase could also have been taken as the theme for this final 4x4 session. This therapist spoke of a new willingness to bring things into focus, to see clearly, and to have the face-to-face conversations about differences that may have been avoided in both parties’ efforts to preserve the other’s positive feelings. But though it might seem counter-intuitive, risking the negative but honest feelings leads to a sense of conviction that the therapist, and indeed the relationship, “can take it,” a strengthening that is a sign of real progress. 

One factor underlying some of these social pathologies, like racism, may be damaged male narcissism. Men who, for whatever reasons, have early on built defenses against profound insecurity may live out an exaggerated form of male identity, based on seeing oneself as more powerful than someone else. Certain societal structures–for example, the gun culture in the US–support this imaginary cure; certain roles–for example, within the military or the police–affirm it; and, when under threat, certain leaders may emerge to enforce it. In the 4x4 conversation, some spoke of related individual pathologies, like substance abuse, which for some men fuels a sense of self-importance, victimization and anger. Others spoke of how important belonging to a community is as a way of transcending this lonely, vulnerable existence. And others spoke of the crucial importance of being a trustworthy presence, willing to speak honestly about the failures of the larger system. The COVID-19 crisis has opened up various heretofore unseen or unappreciated gaps in society, including in the system of care.  At least locally, it has also brought new urgency and creativity to working with those gaps. And it leaves us with a precious opportunity to re-think the future, whether at the level of the delivery of care or the delivery of justice. One very gratifying result of the work so far is the profound gratitude clients are expressing when we are willing to take this opportunity.  

Read Dr. Fromm’s reflections on the first three 4x4@4:00 “Talking It Through” sessions:  

About 4x4@4:00 “Talking It Through”    

Hosted by Jerry Fromm, PhD, ABPP, senior consultant to and former director of the Erikson Institute of the Austen Riggs Center, the 60-minute “Talking It Through” sessions were offered via Zoom video conferencing. Each gathering began with an initial conversation among four mental health professionals related to the feelings people are struggling with during the coronavirus crisis. After the initial conversation among the panelists, the dialogue expanded to other participants, in the hope that “talking it through” would lead to deeper understanding and mutual support.     



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