The intrapsychic pandemonium of a global pandemic

Exploring the psychological impacts of the COVID-19 pandemic has dipped into both my intellectual and empathic reservoirs. It has challenged me to ponder upon my professional and personal journey with trauma. Firstly, it is important to acknowledge that the majority of global society has experienced at least one major trauma in their lives. That is the part of your being that I hope gets to read this – the part of your being that is able to connect with these words from a human perspective. Secondly, it is important to acknowledge the trauma that has been caused by the severe acute respiratory syndrome corona virus.

There isn’t a need to delve upon the physiological impact of contracting the virus. That has been discussed, and information has been widely disseminated. What seems to be the quieter conversation is the psychological impact of living (or dying) through the pandemic. Granted, our journeys will all be different, and how can they not be? There are people who have experienced complex trauma. There are people who have experienced trauma. There are people who have not experienced trauma. There are people who don’t know.

Reflecting on some of the conversations that have been shared with survivors of trauma, I am burdened, intrigued, and empowered. There is something about the corona virus and the subsequent lockdowns and restrictions that are akin to a political war. As we sit in our homes, we are reminded that our homes are no longer just homes. They are both our prisons and our places of refuge. They are now the structures that have been given the mandate to keep us safe from this plague. We sit in our homes, with the illusion of safety. But, are we really safe? What are we even staying safe from? There are no gun shots to remind us that there is a threat to humanity. There are no screams of fear and terror to be heard, but the dread is there. This equation does not balance. Have our autonomic responses been tampered with? Fight, flight, or freeze, right? What options do we really have? We are frozen, imprisoned by an invisible war that attacks us – not through bullets or grenades or machetes, but through contaminated respiratory droplets. Our quarantine partners, friends and family, those who we stay at home with may be the very people who could cause us the most harm, and vice versa. Our family systems have been threatened and our safety nets have been broken.

So as the calendar dates change every 24 hours, to many of us, they freeze in this war. In this intrapsychic conflict, we can’t fight, we can’t flee, so we freeze. Our limbic systems work in overdrive in response to this imminent threat, this ongoing trauma that is working precariously in our unconscious. Many are in survival mode, as the hypothalamus codes what it can. If you have experienced trauma in the past, your trauma response patterns may be recalibrating. This is why we are all responding differently. This is why even within ourselves we may not have the ability to contain our emotions consistently for a long period of time. We are unpredictable even to ourselves…and why not? The world’s predictability has been reframed into statistics of infection, death and recovery [repeat].

Institutions are closed and the streets are deserted. The roar of industry is a distant whisper. As we acknowledge both the collective, and individual trauma that this virus has inflicted, we begin the journey of healing. For the most part, we are uncertain of what it will look or feel like. There are so many dynamics and projections, that it is difficult to know what stage of trauma you are fighting with, fleeing from, or freezing in. It is a journey of knowing that the outside world may eventually reflect some semblance of “business as usual”, but we as human beings are forever changed.

For those of you who have embarked on a battle against complex trauma before COVID-19, I salute you. I salute you for existing and functioning in a traumatic space where you didn’t have the “comfort” of the entire world experiencing it with you. I salute you for receiving empathy, when even your words were never enough to express the fear, and the loss, and the grief. There are many whose trauma has been triggered and there are flashbacks, nightmares, and memories resurfacing of the wars and crimes against humanity, the outbreak of Ebola, the spread and stigma of HIV, the fight against hunger…… To some, this pandemic has a texture of normalcy. To some, there are wounds that have been re-infected. To some, their privilege will see them through.

There is something about working therapeutically with trauma that has been enlightening. Some of my recent existential moments have been inspired by the narratives of the precious and resilient people who have been violated by the injustices of the society that we all live in. I dedicate these words to those people. May their lives remain powerful enough to force us to stay human as we continue down the yellow brick road…

Written by Amina Mwaikambo

yellowbrickroad

Healing the healer

We travel to unknown places – arid, devastated, or even dangerous – both physically and psychologically. We carry this big basket of hope, of life, of sanity. With this heavy basket, we jump through hoops, crawl up walls and are often met with hostility and suspicion, an uncertainty about this new form. We are met with resistance from the wolves in sheep’s skin who are nourished by the vulnerability of the flock.

In the basket, there are parcels of strength and empowerment. There are tools to clear the cobwebs from their dreams and hopes for a future better than this, and a quietening of the noise around to reach serenity within. With the basket in tow, we travel to meet those who are at the edge of their cliffs.

Upon receiving the honour, to trek through the ebbs and flows, to leap through the hoops, and crawl up the wall with this heavy basket, in order to touch those who have reached their limit, we present the parcels and lay out the tools. We seek not to impose, but to tread with caution approaching the lion with a thorn in its paw. We seek not to offend, but to acknowledge, reflect, validate and normalise.

We have swollen faces from turning the other cheek, and soiled lips from kissing “you-know-whats” in order to be allowed to leave an individual, well, Human. We return home. We kiss our loved ones “hello” as they celebrate our return, but we all know we haven’t really returned. We never do. We are never at the point of reclining and putting our feet up. We never allow ourselves. We all know that with bruises barely healed, the soil still grinding our teeth, we’ll be refilling this basket once more, for those we left at home. This healing business is not a part-time occupation, we do it in all corners of the world, including our own, at all levels of consciousness.

We walk into the office, normalised fatigue and all. “Take a self-care day” is the song on our lips and all shall be well. But we don’t know how to practice self-care for ourselves. We hardly do it. We assume that we are automatically attuned to our internal world, and inner peace because we work with others’ internal worlds and help them to stay attuned. Meanwhile, all along we’ve been ushering others to the river without ever stopping for a sip ourselves.

Lest we forget…“you cannot pour from an empty cup”. What makes us great healers, is our humanity, our ability to feel. Let’s be human, and feel.

Refill, restart, reset. Allow yourself to pause, even in chaos. Do not only focus on helping others to regain their equilibrium in a time of turmoil. It is okay to centre yourself. For your benefit, for their benefit. “Breathe beloved”. Heal the healer.

Dedicated to the millions of healers around the world.

By Charlotte Motsoari

silhouette photo of man with backpack standing in seashore during golden hour

 

When only a piece of paper might let you see me…. and even then you may decide that’s not good enough

The influx of displaced people the world over has increased in recent years, with more than 68.5 million displaced people globally and more than a million nationally (UNHCR Report 2017). Of course this number doesn’t capture the true reality of people on the ground as many displaced people are undocumented and so may not be included in the statistics. Individuals migrate for various reasons, some economic, others political. Whether economic or political they come seeking refuge, seeking a better life in another country.

In the past 2 years, listening to refugees and asylum seekers relate the stories of their lives in South Africa, there is a common thread of not being recognized, not being acknowledged and not belonging. Individuals speak about being in the country for 8 or more years and still falling under an asylum seeker permit, or worse receiving 1-3 month extensions. Or their legal documents expire and are not renewed, leaving them in a state of fear, as they fear being arrested for being undocumented and being detained and sent back to the very place they left for fear of death. Our clients live in a state of uncertainty, fear and confusion. They wake up every day and participate in a society that has not yet decided if they belong.

They do not possess the documents that allow them to fully participate in society, that allow them to receive health care, that allow them to have a stable job, that allow their children to get an education. They are the shadows in the dark. They do not want to be seen for fear that you will ask who they are and though they know who they are, they don’t have the right piece of paper to make you believe them or want them.

Taking into account xenophobic attacks in 2008, 2015 and most recently in Durban (2019), this communication of ‘you don’t belong’ is getting more direct, more aggressive and more violent. And though 2008 and 2015 are significant markers of xenophobic violence, the reality is that xenophobia occurs every day in our society: Through the way society engages with labels such as ‘makwerekwere’; perceptions that ‘you foreigners just come to have babies here’; and projections, ‘you come to take our jobs’. Does the othering defend against our own inadequacies as a nation? Can we and do we want to sit with those inadequacies? Realities that poverty, unemployment, corruption in government, poor service delivery and divisions still exist in our democratic, post-apartheid, rainbow nation South Africa? Is our Ubuntu only for those who possess a South African ID?

I have papers (dompas) officer

I am flesh, I am blood

I am emotions of pain, fear and sadness

I also possess the ability to laugh, smile and feel joy

I am human or have you forgot

Because the paper that I hold says refugee

Because the paper that I hold says seeking asylum

Because I hold no paper

Have you forgotten that my veins are blue and my blood is red

Have you forgotten that I too have a family and want the best for them

Have you forgotten that I too feel hunger pangs

And worse pain when I see my baby crying from the same hunger pangs 

Because my paper doesn’t allow me to work a stable job with benefits

Because my paper doesn’t allow me to think of a future beyond this week

Because I have no paper

You have forgotten my humanness 

You have forgotten we are one human race

You have forgotten I have the same human rights like you

You have forgotten your principles of Ubuntu

And so I lurk in the shadows with hopes that you don’t see me

Because even if you do, I don’t have the right paper for you to see me

Not as a refugee, asylum seeker

But as you see yourself: human, belonging, deserving, a mother, a father……

 

Written by Sumaiya Mohamed

Beginnings and premature endings: A therapist reflection on termination in therapy

The process of termination in therapy is often one fraught with intense emotions for both the client and the therapist. I find that this can become increasingly more intense when terminations are premature. As I therapist I feel incredibly guilty when I have to terminate with a client before we have done all the work together that we could have.

In the context in which I work where the majority of clients have experienced horrific losses and often feel unsupported, isolated and alone in their worlds, I always feel like I am playing into this dynamic and their sense of abandonment when the time for termination arises. But the reality is that as a therapist, we cannot be with our clients forever, we cannot assist our clients on their journey to healing to the extent that our minds and hopes desire. Nor do we have that control over things. But as a therapist, it is hard when I feel that I have not done what I could and that I am making their process of healing even more complicated. However, it is also all MY voice that feels that I am at the centre of the termination. As if I am letting the client down or that I am abandoning them. But the truth is that I am not the most important element of this process.

There are times when I have had to prematurely terminate with clients, but despite what I felt in the room, I allowed them to say they are fine and that they understand why this is happening and in doing so I facilitated their avoidance of what this ending may mean. This is particularly important based on how I work as a therapist within the context that I do. Due to all the contextual challenges clients face, we often sit in a space of crisis management and help in the avoidance of the difficult feelings and memories attached to traumatic events and the circumstances that have led them to therapy. Avoiding avoidance, so to say, is necessary to navigate the unfolding of the therapy process, which can lead to beautiful insights.  In doing this there is a relationship and trust that forms.

Furthermore, in the context of the work that I do where it can often be difficult to do pure therapeutic work, the foundation that I have worked from is trying to allow my clients to see that they can trust another human being. In doing that they can try and get the support they need to get through the difficulties and challenges they face. But trying to translate this into practices outside of the therapy room is a long process. So when I terminate before this point I feel like I have not finished what we started together.

And this is the position I find myself currently in. I have endured premature terminations before, but I have found that this time some of them are a lot more intense than previous ones. In reflecting on this, it is clear that it is the depth of where we have gone together in the therapeutic process, the level of trust created in the space together, the things that they have never explored with another before and those are the things I have taken and held but am handing back and leaving them with before they are entirely ready. So, in sitting with my feelings of guilt at having to tell my clients that we were ending and feeling the need to make it a pleasant and easy process for them, my supervisor pointed out something important: That through the process of therapy and in ending we cannot be the all good object but if the process of termination is handled properly I can hope to leave my clients with the ability to integrate good and bad in one object. That through this they will be able to hold onto the good parts after the termination and remember the things they need to when facing challenges. But that if I don’t and we don’t think and talk about the difficult parts then they will either shut that off and may see me as an entirely bad object and in doing so never access me (and the things done in therapy) for support in the future.

So in introducing the terminations this time around I was horribly aware of needing to do this for my clients. It was difficult sitting in the room being told I am ‘breaking a heart’, or that I am ‘loved and in leaving will create an emptiness’. The pain in this at times became almost unbearable and I wanted to run away, but sitting in it and tolerating it was what I needed to do. So for sessions we spoke about the imminent termination date and the difficulties related to it. But through this process we also spoke about the things that helped make sense of it and in speaking about it I could see the shifts in my clients. When my one incredibly emotionally avoidant client could articulate that he was sad about us ending I felt such happiness. Through difficult moments there can be moments of such intense beauty and growth.

I have reflected on this in relation to my own personal spaces, such as therapy and supervision, that have pushed me to spaces I have not wanted to go but places that I have needed to in order to grow. There is a sadness and beauty in ending something that has allowed a sharing of parts of you that are hidden to the rest of the world. What those spaces have shown me is that the hard, difficult and broken parts of me can be shared with and tolerated with another human being without them hurting me, judging me or running away. So a termination is like the end of a movie, there has been a story together and difficult choices made but that in the end the final decision is to leave and say good bye, the ending is inevitable. But in saying good bye, the memory does not leave. Through the difficulty of it there is a growth that occurs and there are parts of both of you that are changed forever.

Written by Jacqui Chowles

#MentalHealthMatters

1 in 3 South Africans will suffer from a mental illness in their lifetime (South African Depression and Anxiety Group)

Suicide is the second and “fastest growing” cause of death amongst 15-24 year olds (Mental Pressures can force youth into suicide-Karabo Ngoepe-Sunday Independent News).

Today marks World Mental Health Day, the theme for this year is ‘Young People and Mental Health in a changing world’. Reflecting on this theme, two thoughts come to mind: the increase of suicide rates amongst youth in universities across the country; and the stigma of mental health which continues to persist in our society. As a psychologist working with youth, depression is noted as a common feature, and as we hear more and more about youth suicides, there is a need to explore and understand the links between depression, youth and suicide in our society today.

Speaking to various mental health practitioners in the field working with youth, discussions have been around the societal pressures that youth face. The pressure to be smart, fabulous, a slay queen on social media, a real man, a successful academic. These pressures combined with financial pressures and limited social support structures has an impact on youth’s ability to navigate their social and personal world. Other practitioners have had conversations with youth, who have related their mental health struggles to issues of worth and purpose. As youth, feel they have no role to play in society today. In comparison to youth in the past that fought for Freedom. Highlighting an identity crisis where society cannot grasp what they are becoming or what is needed for them. They are referred to as the ‘millennials’, often thought of as lazy, not as robust as the generations before, having a sense of entitlement and lacking a hard work ethic. And the more connected they are through social media and other platforms of connection, the more isolated and disconnected they appear to be from their peers and even more so authority structures such as Universities, Government and even social support structures in society. Youth have found it hard to take their struggles to these platforms, feeling people don’t care, youth are seen as not doing enough, ‘the generation before did it why can’t you?’ And this often leaves them feeling alone and stuck. Reflecting on the incidents of suicide in this year amongst youth, many thoughts of why come to mind. Didn’t they have a friend to speak to? Someone to hear their cry? No one just decides to kill themselves, depression has a starting point and intervention can make a difference. So why is intervention happening too late or not at all.

The silence around mental illnesses is still a major problem in our society. And more so amongst our youth. As mental health issues in youth are often brushed aside (‘you will get over it’; it’s just a phase’), misunderstood and not received empathetically. As youth report that they are seen as weak if they are not coping, or pretending to cope. So they suffer in silence, attempt to manage their difficulties on their own and are not accessing support structures available to them. Raising awareness to decrease stigma is important and a starting point to get people to talk about mental illness. The more it’s talked about, the more it can be normalized and a part of conversation in society. Not seen as something that has to be kept a secret  and that if people do find out, will think you ‘crazy’, incompetent, not strong enough. How do we go about doing this? How to raise awareness and acknowledge mental health and illness as a part of the human experience and not something alien to us that has to be hidden, shunned and ignored?

I think it starts with each one of us, taking the time to educate ourselves, to understand mental illnesses and each other and not judge. To create safe spaces amongst ourselves, peers, families and communities to acknowledge the experiences of each, whatever that may be and engage with it, with empathy.

Today marks World Mental Health Day, this month marks World Mental Health Month, but the importance of mental health on us as individuals, families and communities is ongoing and requires ongoing attention, advocacy and support.

There is no health without mental health (World Health Organisation)

Written by: Sumaiya Mohamed

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