Abstract
Had psychoanalysis not rediscovered the body in the past quarter century, it would have been forced to start afresh and begin to grapple with its contours in new ways during the time of the pandemic. Recent attention to the body-mind with its unique rhythms, discomforts, sensations, and carriage provide au courant scaffolding for the analyst to heed its potential messages from the unconscious and to deliberate on them in sessions. One can enter this newer territory assured that one had not wandered too far afield from traditional grounding in theory and practice.
Within weeks of stay-at-home orders and a frenzy of activity to establish virtual work from home, waves of acute fatigue set in. Patients complained of exhaustion and irritability. Each had taken reasonable steps toward self-care and most were among the fortunate ones who could earn a living and rely on loved ones for support. Why so prickly, insecure, and reactive to infractions such as a dropped conference call or request from a boss or colleague to do just one more thing? Tendencies toward self-recrimination worked through months or years before now blossomed anew. They manifested themselves not only in guilt- and shame-filled verbiage but in long, epic dream narrations and subtle physical symptoms. Some days it took the full force of the analytic carapace not to shut down my computer, toss the keypad gauntlet, and helplessly shrug off these complaints, beleaguered as I, the analyst, was with similar strictures and annoyances.
Ironically, psychoanalytic and supervisory work kept pace. The strain of the new modes of meeting together, such as videoconferencing, was lightened by the generous coaching of several supervisees. Identification with their ease facilitated the transition across a heretofore digital divide that I experienced with a newfound sense of liveliness and mastery. People reached out from years ago to reconnect or simply check in, and current patients spoke of potential breakthroughs, real and imagined, because the crisis shook their sense of safety and blasted through levels of denial.
Expectable bumps occurred as we adjusted. After settling into the new frame, it was easy to drift to familiar narratives or to slide over the deeper anxieties and losses uprooted by the pandemic. Nostalgia for my office—the placement and texture of its chairs and couch, familiar external noises, art and important personal objects—also left us feeling unmoored. Finding a way to acknowledge the distinct kinesthetic sensations evoked by these reminiscences was one entrée into another layer of discovery and loss that linked past with present. “Good analytic work is going on,” as my friend and colleague Stanley Coen (1992) might salubriously point out, intimating that facing and tolerating these fluctuating affect states facilitates self-management and growth in the treatment. Yet for both patient and analyst, what had started out in a scary and fraught circumstance grew more wearying by the day and now seemed endless.
By coining the term pandemic fatigue in my practice, I hoped to find a shorthand for registering and normalizing a distinct amalgam of bodily and psychological symptoms I sensed was ubiquitous in anyone who did not have Covid-19 or was among the first responders charged with fighting it. Those responders were dealing with immediate life-and-death concerns and would likely need psychotherapeutic attention down the road for acute and chronic trauma. Those with the affliction of pandemic fatigue still needed care and refuge lest exhaustion, impatience, testiness, fog, or disorientation ratchet up or spiral into significant physical or psychological illness.
The concept of complemental series helped me explain to some patients and students that a complex layering of hereditary, biological, psychological, and cultural factors plays a role in the manifestations of any illness. The concept, shelved in the back of my mind, sent me to Auchincloss and Samberg’s Psychoanalytic Terms and Concepts (2012) to make sure I had it right. Indeed, several supervisees had never heard of the idea. It was striking then to see superego pressure recede a bit as they gleaned and owned some appreciation of the many forces that impacted our bodies and psyches as we were hurled into the societal disruption of Covid-19.
Because it felt useful to teach in this way, I decided to write about elements of pandemic fatigue for the popular press; in this forum I was free to offer direct advice about steps to ameliorate problems I was encountering daily. I began to encourage being aware of the simple moments we all must grab for rest and to allow mind-wandering to balance the suggestions offered in the media for a more action-oriented program of exercise routines, online classes, and precise, structured scheduling. I was learning on the fly from clinical practice that free association was more important and helpful than ever.
Actual clinical work requires a somewhat different approach and is yielding some surprising results. For years I have returned to Elvin Semrad’s notion of taking “a tour of the body” (Adler 1979) to assist analytic and psychotherapy patients in coming to know, bear, and eventually integrate split-off affects. Semrad found in his work with psychosis that individuals enhance their awareness of feelings by asking exactly where an affect or sensation in the body is located. Semrad’s idea can be extended to inquire about the fantasies and narrative that emanate as one tours one’s own body, keeping a simple question in mind: What occurs (or is remembered) as you linger at your (name body part) right now in the session? This process eventually facilitates introjection of the analyst, who demonstrates, by example and in the transference, a willingness to uncover and bear along with the patient all the human recollections, piquancy, strength, and frailties that may emerge.
After claiming their need for rest, taking some, and then following up by the respite provided within the analytic session, patients are quickly migrating to their individual points of impact. Fear and dread surface. An ache in the chest kindles associations of a parent’s death. Imagining perfect body symmetry now harkens a latent wish to omnipotently anchor internal organs and to claim restitution from the errant universe responsible for near fatal childhood trauma. Headache gives way to rage after concluding that the situation of meeting over the phone will likely go on indefinitely and that the analyst cannot fix it. I am experienced more than once as a robot for the first time in my long career.
Each of these referents signals to the analyst the inexorable limitations of the body and the corporeally experienced question of how—or even if—patient and analyst will return to each other the next day to keep learning and bear witness. It is all so very different and cobbled together. I take some solace because something appears to be happening that is human—and analytic—and I hang on by a thread to a quote from Anne Alvarez (1992): “There is no loss without a previous experience of something gained, and surely it is this lifelong rhythm of gain, loss, gain, loss, reunion, parting, reunion, parting which is what human relationships and human life are about” (p. 129). This cycle is replenished by pausing, taking stock, and providing the interpersonal nourishment necessary to weather the storms of pandemic fatigue.