...in this moment of crisis, we must also become active narrators of our own life stories. We must continue to live our lives, but we also have an urgent need to write our life stories, whether with quill pen, with keypad or, simply, through conversations with friends and loved ones.
by Professor Brett Kahr.
Over the last forty years I have worked full-time in the mental health profession, providing intensive psychotherapy and psychoanalysis to numerous individuals, couples, and families suffering from great distress.
Although most of my days in the office can be described as reasonably straightforward and survivable, focussing exclusively upon the private woes of my patients, from time to time the outside world has burst upon me and, indeed, upon all of my colleagues in far too ugly a manner.
I remember only too well the shock and horror of working from my consulting room in Hampstead, North London, on the 11th of September, 2001, when two planes crashed into the World Trade Center in New York City. In consequence, many of my patients began to experience panic attacks and deep fears, full of dread lest some terrorist organisation might perpetrate a similar atrocity in the United Kingdom. And I certainly recall the even more frightening day in the office when, more locally, on the 7th of July, 2005, four young men, previously unknown to authorities, exploded a series of bombs across Central London, resulting in many tragic deaths. In the wake of these horrific, sadistic assaults, my patients endured even more severe episodes of anxiety, depression, and suicidality, wondering whether life had lost all meaning.
But nothing could have prepared any of us for the unparalleled eruption of the current global pandemic, from which none of us can possibly feel fully protected, no matter how carefully we self-isolate and no matter how many times per hour we wash our hands. This viral outburst has forced us all to confront mortality in such a stark manner, and it may come as no surprise that my psychological colleagues and I have received innumerable frightened calls from patients – current patients, past patients, and, moreover, prospective patients – all of whom wish to, or need to, embark upon psychotherapy in the upcoming days, weeks, and months, desperate for emotional assistance as each of us struggles during this extraordinarily painful chapter of human history.
At the very outset of the pandemic, many psychotherapy patients minimised the threat of the virus, perhaps as a rather understandable expression of self-protective denial. But as this illness has spread worldwide, many of these individuals have subsequently erupted into panic attacks, hysteria, and terror. A colleague in the United States of America has expressed, rightly so, that, at present, the world currently faces not one pandemic, but, actually two: a virological pandemic and, also, a pandemic of anxiety.
In my experience, no two people convey their fears in quite the same fashion. Some have verbalised their deepest dread in a robust and sanguine manner; whereas others have begun to manifest hyperventilating panic attacks, deep clinical depressions, and even episodes of dangerous suicidal ideation and behaviour.
Some patients undergoing psychotherapy have even transformed their terrors – quite unconsciously – into crippling and painful psychosomatic symptoms. For instance, only days ago, a young woman rang me for a psychotherapy session on the telephone. Although I would ordinarily meet with this patient in my office, I have, over recent weeks, had to transform my face-to-face clinical practice into a telephonic one, in order to respect the understandable necessity for social distancing. This lady, whom I shall call “Ms. X.”, began the session in a state of deep distress, explaining that, overnight, she had begun to experience frightening crushing pains in the centre of her chest. In spite of being a relatively young person in fine physical shape, with no family history of cardiac disease, Ms. X. feared that she might be having a heart attack.
Although one cannot properly diagnose heart disease over the telephone, Ms. X. confirmed that she manifested none of the most obvious red-flag symptoms (e.g., pains radiating down the left arm, sweating, shortness of breath, etc.), and, in consequence, she requested that we might persevere with our psychotherapy session as she had much to report. Needless to say, I monitored the conversation like a hawk, fearful that we might have to telephone for an ambulance, and even more fearful that, in view of the pandemic, a London ambulance might not be at all obtainable.
As our fifty-minute-hour unfolded over the telephone, Ms. X. began to verbalise one fear after another: a dread of her elderly mother contracting the Coronavirus; a terror that she, too, might also become ill; and a concern that she might never see her friends again in this lifetime. Additionally, my patient reminisced about other horrid events in her childhood, all triggered in her mind by this viral pandemic, including a ghastly experience of child abuse, which had made her feel bodily “infected”. Ms. X. spoke without restriction, articulating fear after fear. She even dared to express a secret desire that her boss, who often treats her quite cruelly, might die from COVID-19, ranting, “No one deserves a viral death more than that damned bastard.” Indeed, across our conversation, Ms. X. had no shortage of fears of death on her mind as well as death wishes!
After speaking non-stop for approximately thirty minutes, I sensed that Ms. X. had become infinitely more calm in her vocal tone and the initial quality of panic had disappeared entirely. She no longer sounded quite as manic as she had done at the outset of our session.
At this point, I asked Ms. X. about the chest pains, wondering whether she still experienced any symptoms.
The patient replied with some bewilderment, “Chest pains? Oh, yeah, my chest pains. Gosh, I’ve completely forgotten about those. Do you know something, I think they’ve disappeared completely!”
Happily, I breathed an immense sigh of relief, thankful that the patient’s “presenting symptom” had abated so considerably. I then interpreted to Ms. X., in old-school, Freudian fashion, “I wonder whether the chest pains have disappeared because you have now managed to verbalise much of the anxiety and terror and unsafety that you needed to get off your chest.” At this point, Ms. X. burst into tears of relief and, by the end of our telephone session, the patient felt infinitely more peaceful and hopeful, in spite of the fact that the Coronavirus still continues to rage across the planet.
I could provide many more vignettes of this nature as my colleagues and I continue to work with people who carry so much unprocessed life-history in their bodies, especially at this very challenging point in time, much of which often erupts in symptoms of both a psychological and a psychosomatic nature. Additionally, those with pre-existing medical conditions, such as asthma or rheumatoid arthritis, have reported that their bodily pains have become much worse during the pandemic, exacerbated by anxiety, and thus indicative of what we would refer to not as psychosomatic symptoms but, rather, as somatopsychic ones.
By providing Ms. X. with a space in which to narrate her life story, I did little more than follow in the pioneering footsteps of the Viennese neurologist Dr. Sigmund Freud, who, from the 1890s onwards, allowed his long-standing stifled patients to “write” their life stories in the confidential privacy of the psychoanalytical consulting room, while reclining on a comfortable divan. Freud took life-writing extremely seriously, and he noticed that those who “write” their lives, whether with nineteenth-century quill pens or with spoken words, will enjoy the potential to experience a profound catharsis by “getting it off their chest” and by verbalising the unverbalisable, revealing shameful secrets, painful traumas, terrifying fears, desperate hopes, and unmentionable sexual desires.
Freud’s method, known originally in German as the “Redecur” or “talking cure”, and now codified more formally as psychotherapy or psychoanalysis, has, over the last century, received immense confirmation from experimental psychologists worldwide, large numbers of whom have underscored that the sheer act of talking or writing about one’s life history often provides tremendous relief from basic psychological distress. For those who wish to learn more about this heaving body of research, one can do no better than review the contributions of the American psychologist Professor James Pennebaker of the University of Texas at Austin who, across many decades of sturdy investigation, has discovered that the simple act of keeping a written diary of one’s daily travels and travails will facilitate a reduction in both psychological and physical symptomatology. Often known as the progenitor of “writing therapy”, Professor Pennebaker and his research colleagues have demonstrated the long-term health benefits of transforming one’s thoughts into words.
During this heartbreaking global pandemic, many of us spend our days in rather passive silence, glued to the television, watching the repetitive and traumatising newsfeeds. Of course, as concerned citizens, we have a duty to learn about the latest medical advice. Still, in this moment of crisis, we must also become active narrators of our own life stories. We must continue to live our lives, but we also have an urgent need to write our life stories, whether with quill pen, with keypad or, simply, through conversations with friends and loved ones. By getting it off our chest, by engaging in catharsis, by finding some way to write our lives while also living our lives, we will have a greater opportunity to enjoy a sense of relief.
Naturally, we have no obligation to produce a slick autobiography, intended for publication, in the manner of St. Augustine, Jean-Jacques Rousseau, Maya Angelou, or Michelle Obama. But we do need to find a way to translate our unbearable feelings into language. Indeed, in between our bouts of compulsive handwashing and social distancing, we have the potential to derive tremendous comfort and relief from the long-venerated process of verbalisation, whether by writing on the page, by chatting over a cup of coffee, or by conveying our fears and secrets to a psychotherapist who might well, at this point in time, be listening to us by telephone or by Zoom, at least for the foreseeable future.
Professor Brett Kahr is Senior Fellow at the Tavistock Institute of Medical Psychology in London and, also, Visiting Professor of Psychoanalysis and Mental Health in the Regent’s School of Psychotherapy and Psychology at Regent’s University London. A Consultant Psychotherapist at The Balint Consultancy in London, he is also Chair of the Scholars Committee of the British Psychoanalytic Council. His most recent books include: Bombs in the Consulting Room: Surviving Psychological Shrapnel (Routledge, 2020) and Dangerous Lunatics: Trauma, Criminality, and Forensic Psychotherapy (Confer Books, 2020), written for psychological colleagues, and, also, Celebrity Mad: Why Otherwise Intelligent People Worship Fame (Routledge, 2020), intended for a more general audience.
Copyright © 2020, by Professor Brett Kahr.
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