ALICE IN 2021 (Part 1)
A “My Journey” post By Sol Riou, MSW, retired LICSW
The following submission is a Washington state social worker’s accounting of her Covid journey with patients “down the rabbit hole.” This series will be published in four parts.
Views and opinions expressed in “My Journey” posts are not necessarily those of Children’s Health Defense.
PART ONE
I began my descent into the 2021 Rabbit Hole before the Covid pandemic.
In my job as a social worker, I meet with patients who are anxious and depressed. After thirty years of helping individuals change their emotions by changing their behaviors, I feel confident in my job as a cognitive behavioral therapist. My first patient of this day in March of 2020 is an intelligent and articulate 14-year-old young woman. I have a lot of respect for her.We’ve been working together for several months on test anxiety. In preparing for our therapy session, I review her chart and find a new medication listed there, to stop her from biting her nails. I think, “Why? She has never even mentioned to me that she bites her nails. She has asked me to help her to change her negative thinking habit when she sits to take a test at school, especially math tests, which cause her mind to go blank. If she doesn’t want to bite her nails, we can solve that without the need for her to take a medication with unwelcome side effects for the rest of her life.”
I know what has happened. This isn’t the first time that a patient’s primary care provider received a recommendation directly from the staff psychiatrist offering a pharmaceutical solution to a behavioral problem; chemical interventions are believed to be more effective than behavioral interventions in this clinic where I work.
I believe it was years earlier when I began asking myself “Why?”This rabbit hole of cognitive dissonance briefly opened when I was only twenty years old living in Barcelona, Spain. I was having dinner with my husband’s family. I was newly married to Jorge, a handsome young Catalan man. The topic of conversation was the Watergate political scandal. I was shocked by the corruption and political coverup and exposed my naiveté stating, “How could this happen in America? We have a democracy. This should never be able to happen in a free democratic country.” Laughter erupted among the family. My brother-in-law chuckled, “The only thing different between our government and yours is that we know our government does not serve the people’s interests, and in America, you believe your government does.”
I couldn’t believe what I had just heard. Spain had a fascist government at that time. General Franco and his police, the Guardia Civil, were feared by every person that I had met in Spain. Social gatherings of more than ten people were illegal unless all attending were related. I survived that adventure for only three years, returning to the United States feeling trapped due to the lack of rights for women. I was not allowed to open a bank account; only men could. I was not allowed to get a divorce, ever. And now that I had a husband, I could be jailed for adultery, yet the adultery law did not apply to men. When sharing my concerns with my mother-in-law, she chided, “In Cataluña, we women are liberated; our husbands walk beside us and help to carry our groceries, not behind us with empty hands like in Andalucía.”
Sitting now with this young woman, we are not talking about her test anxiety; instead it is about her increased anxiety due to the cancellation of school starting Monday. I share her anxiety. Our governor has declared a “lockdown”; all non-essential business and services will be closed due to the COVID 19 virus. And he has mandated that all citizens “shelter-in-place”; we are to leave our homes only for essential activities. An emotional numbness consumes me. Instantaneously I feel that I have fallen into a dark hole; I feel completely ungrounded. I can hardly speak. I can’t continue to listen. Yet I can still breathe. So I begin slow deep belly breathing in hopes that this will return me to functioning. My patient is crying and speaks through her tears, “My best friend is no longer able to visit her father on the weekends. And I can’t even walk across the street and give her a hug. I’m not allowed to be with anyone outside of our family.” I cry too inside; my mind screams “fascism!” Yes, that’s it, Spain! This is a familiar fear. The somatic memory of my nervous system under fascism pulls the ground out from under me, and I fall into a chasm. My body understands the lack of freedom to connect with others, and the constraint of movement outside of your home. My mind understands that I am not in fascist Spain but in the United States of America, an apparently free and democratically run country. My mind understands one thing and my body quite the opposite. “This lockdown is to protect me,” I say to myself, yet my body is feeling imprisoned rather than safe. My mind wonders ,“Is my government really looking out for my best interest?”
Deep belly breaths and focusing on a picture over my desk of my favorite beach return me to my office, grounded in the present moment and a sense of safety. To aid her in her return to a feeling of safety, I ask the young woman the following questions:
“Can you feel your feet on the floor?”
“Does the floor feel solid to you?”
“Do you see or smell anything dangerous around you, here in this room?”
I focus my patient on her five senses and the reality that we are safe in this moment.
* * * * * *
Is it the looming 2020 presidential election? Or is it the fires that are filling the skies with smoke this summer, so thick the sun is red at midday? Is it the daily marches crying out “Black Lives Matter,” yet police officers still murder unarmed African American men? I have found it difficult to breathe almost every day this summer. Even as I mindfully attempt to fill my lungs with a slow deep belly breath, my body resists. I know how to do this. I teach this stuff. What did that recent training “Treating Anxiety during the Times of Covid” recommend for patients? I search my memory and remind myself of the three cognitive skills: lower your expectations, practice gratitude, and focus on what you can control. Breathing slow deep breaths, my breath still stops at my clenched jaw. Then I remember that I often have to add a fourth skill, a somatic skill: “Connect with the physical feeling of safety in your body in the moment.” I decide to walk to work today and ground my intense emotions by focusing on gratitude for the beauty of nature.
“We can’t breathe,” I say out loud to myself as I step out my front door into an air quality index of almost 300. It’s not just me! None of us can breathe until they find a vaccine for this deadly COVID virus, until the police stop killing bodyguards at bight clubs just because they are Black, and until the forests stop burning from our climate crisis.
I now see all patients virtually through a telemed program. Soon after our governor announced the statewide “shelter-in-place” order, instead of face-to-face visits, only virtual visits were permitted, and telemed was installed on my computer. My clients are now an image on a computer screen. The rabbit hole engulfs me again as I log on to my computer to start my day. “Shelter-in-place” is a war term. “Soldier through”–what a sobering image to embrace. And worst of all is the “social distancing.” (Is that an intentional misnomer?). We are asked to avoid being closer than six feet from others–that is “physically distancing,” not “social distancing”. My previous career was in advertising, so I understand the power of language. I ask out loud to an empty office, “Are these phrases subliminally influencing us to socially isolate and stuff our feelings?” How unhealthy; human connection is a basic need. Sharing our pain and fears during this time is the way to emotionally survive this lockdown. Staring at my unopened emails, I am unable to focus my mind on my work. I scribble a poem on the back of some unopened mail, entitled “We Can’t Breathe.” I feel grounded again. Relieved, I open the telemed program to greet my first client of the day.
She shares about the recent death of her 10-year-old daughter. She speaks in short bursts, holding back her tears, “There won’t be a funeral. None of my family wants to risk the trip. Even her father can’t come; they have closed the border. Just her younger brother and I to bury her. So young to die.”
Patient after patient bring me their stories of how the pandemic has disrupted their lives.
“I know it is elder abuse, but nobody answers at Adult Protective Services. I guess it is closed due to COVID.”
“I called the police about this violation of his no-contact order. The police said they can’t enforce it. The jails are full, and they can’t overcrowd them because of COVID.”
“It was a head-on collision, yet there were no hospital beds available. They just sent me home with pain meds. And I had nobody to care for me.”
“I am so lonely . . . no visitors are allowed . . . my son used to come by every day on his way home from work . . . I miss my friends who shared my table in the dining room. Now we aren’t allowed out of our rooms. I dine alone in my room. Every day. Every meal.”
“I don’t have any more anxiety. I got rid of my radio. That was the problem. I strongly recommend it. Take a media fast; just don’t listen to the news. I don’t need to know what is happening. It is so awful . . . no solutions, just problems. Instead, I listen to books on tape and watch comedies or old movies on Netflix. Laughter is the best medicine, you know.”
I don’t resign that day. I apply for family medical leave. I venture off into the mountains, camping for a month. Like my patient advised, “no news; a media fast.” Ahhhhhh… I return to work revived, just in time for the seasonal holidays.
* * * * * *
“None of the family came for Thanksgiving this year.”
“We canceled our plane tickets to fly home and spend Christmas with the family.”
“I ate turkey with cranberry sauce alone.”
“We are planning to open our gifts together over Zoom this year. And with Jerald ill, it may be our last Christmas together.”
I, too, spend Thanksgiving alone. My Christmas will also be on Zoom, little computer pictures of those precious little grandchildren of mine, instead of warm hugs and kisses with each. I live alone and am now nine months without a single hug.
My next patient is a 16-year-old who has been living with her boyfriend’s family. She is afraid of causing her mother’s death by giving her autoimmune-comprised mother the virus.
I rise to the occasion, yet only physically. I hear my voice introduce myself after five years in this job. It is from rote memory: “As a social worker, I was taught that my job is to offer something that looks like help. How can I help you?” I listen physically, and my mind and emotions remain on my breath, breathing in, breathing out. I can still listen and talk, saying what therapists say: “And when did this start?” “What has worked so far?” “Where do you find support?”
When she leaves my office, I leave also. I walk. I walk and breathe until I can return to my body. I notice that I am late for my next patient. I begin again by rote memory introducing myself: “As a social worker, my job is to offer you something that looks like help. How can I help you today?”
END OF PART ONE
STAY TUNED FOR PART TWO OF THIS FOUR-PART SERIES
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