Suffering,social work and the old masters

Working as a hospital Social Worker during a major viral pandemic was always going to be an interesting and unpredictable experience. We knew the COVID-19 virus was coming, but at first it seemed far off. For many of us, like death. Within weeks it had arrived in Australia and our society transformed overnight - a lot was changed or lost very quickly. Our sense of mastery over our lives, that fundamental perception that allows us to daily pursue our ends, was shot to pieces, our busy-ness exposed as a modern-day disguise for the conceit that death was a long way off and would not come, as Proust contemplated a hundred years ago, this very afternoon.

“We may, indeed, say that the hour of death is uncertain, but when we say this we think of that hour to ourselves as situated in a vague and remote expanse of time, it does not occur to us that it can have any connexion with the day that has already dawned … (Proust, 2000: 360).

First came the tsunami of information. There seemed to be nothing else on the news or social media. We awoke to notifications of the latest figures in Italy and Spain, horrible figures that were hard to grasp, and our own slowly increasing toll, and just in case it wasn’t close enough to home, the latest high-profile casualty or young person struck down. The statistics became all-consuming. At the end of each day, were our state infection numbers up, or down?

The hospital where I work as a social worker doubled its Intensive Care Unit (ICU) capacity within a week, and wards prepared to receive the viral masses. Our Social Work department planned a Model of Care change that encapsulated all processes from family meetings, accommodation discharge options, public health information, liaison with interpreters, post-mortem viewings, and funeral information. It was a new world, with new laws. We quickly became expert at remote technologies.

Over the weekend of the 28th and 29th of March, three shipping containers were delivered to the hospital grounds. Were they for protective equipment storage, or to be used as morgues in bleaker times to come? Signs all over the hospital discouraged visitors, a concierge service popped up to vet all entry points and encourage hand hygiene. It all felt like the end of something rather than the beginning. Then, we waited in the eerie quiet for the tsunami of illness to hit.

Social workers are used to working with loss and change, and with testing and frequently challenging received social policy wisdom. A crisis like this was in our wheelhouse. In this new world, clear, consistently received wisdom was difficult to come by, and suddenly, when we all needed to socially distance together, any sort of radical practice seemed almost a threat to our existence. Practice seemed reduced to its bare bones, navigating rapidly emerging policies and implementing them quickly in an environment none of us had experienced before. And sitting with human suffering, trying to ameliorate it through human, distanced contact, wondering if that suffering would visit you soon.

“I’m really stressed”. These were the first words a COVID-positive patient said to me, a man in young middle age admitted to hospital. Stressed at first because of the distressing respiratory symptoms, and then after he was feeling better, stressed because he was around “sick people”. He tested positive, then negative, then positive again, throwing a meticulously planned discharge in to disarray. Science knows something about Coronaviruses, having faced them before in Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). A literature search on psychosocial effects of these viruses though, makes for scant reading. Most evidence is medical and epidemiological, although there is some evidence of psychological effects on Emergency resident physicians during MERS (Al Ghobain et al., 2017) and the psychological impacts of quarantine (Brooks et al., 2020) leading to acute stress disorders.

Distanced from our colleagues at work and isolated from family and friends away from work, acutely stressed and waiting for the vaccine, what we needed in the meantime was a measure of certainty and consolation. Stuck at home with time on our hands, we could reach for our bank account statements, or for imaginative worlds to reflect or escape our predicament. Albert Camus’1947 novel The Plague seemed suddenly prescient. We were in a similarly uncertain world, stripped of conceits that our medical and scientific advances would save us from the fate which Camus’ Dr Bernard Rieux witnesses. It seems absurd in The Plague when funerals are banned for fear of contagion and bodies are buried en masse in quicklime, yet here we were, limiting our funeral attendances and considering temporary mass burials (Allen and Neuman, 2020). We may ordinarily not give much thought to the times and people of the imaginative past, who seem somehow undeveloped and less advanced than us, but literature like The Plague shows us that we can at least know that our experience is part of a long tradition of losses, all very alike in nature and feeling. This is an individualism with the self at the centre of a shared experience, rather than the self as the centre of all experience.

Every day in the COVID-19 world the self was buffeted by new modelling, opinion, worry, anxiety, barrages of news, spin and statistics. It came at alarming speed and none of it was reassuring for long. We continued to try to make meaning and to sit with our uncertainty as things took their course. This is what human beings are practised at and it is the aim and the salve of all types of art that have cut through the daily grind since antiquity. “Give me life”, Falstaff declares in Shakespeare’s Henry IV Part I (Shakespeare, 1988: 397), when given the option of an honourable death in battle. Being remembered fondly is not as compelling for the old man as being here.

And while we are here – in this society, at this time – one way in which meaning may be derived or anxiety may be suppressed is through immersion in literature, where characters like Bernard Rieux and Jack Falstaff are among the many eloquent, imagined precursors to our grief and loss theories. Seeking a break from the information tsunami, readers can interact with characters and situations in such a way that encourages sustained, meditative reflection, an activity which is also a fundamental part of a healthy grief experience. Reading literature also exposes us to complex emotional and relational situations which we are able to approach from a safer emotional distance than those we experience in our own lives, such as viral pandemics with their far-reaching repercussions. There is also the potential for our understandings of these experiences to become more than just logical, as we undertake imaginative rehearsals for emotional experiences to come, achieving familiarity with emotions that, appearing as if for the first time, in fact recur endlessly in each individual human vessel.

Utilising literature in this way can be undertaken prescriptively, in the form of bibliotherapy (i.e., recommending particular forms of literature to others to overcome particular problems, Pierce, 2015, Riordan and Wilson 1989) or as part of a process which takes place almost incidentally as we seek solace in the powerful words of the old masters. The ability of literature to assist recovery and provide consolation may be enriched by taking the latter approach, as we explore the smaller places than we are used to examining, experiencing quiet revelation in the musical notes as much as the symphony (Davis and Billington, 2016). If we were to view literature, or indeed the experience of human distress in this way, a particular therapeutic approach is no longer necessary. It is simple:” the world imagined is the ultimate good” (Stevens, 2015: 555).

There is also the possibility that, in taking a more prescriptive approach to engagement with literature our facility to engage empathy – the development of moral imagination – may be thwarted (Bromwich, 2014). If Bromwich is right and it is through imagination that we get to empathy, then WH Auden (1991: 179) was as prophetic as he was poetic in writing: “About suffering they were never wrong, the Old Masters”. Auden goes on:

how well they understood

Its human position; how it takes place

While someone else is eating or opening a window or just walking dully along;

This is suffering as normal human business, not far away but here in our daily lives, and indistinct from us and our families. Neimeyer and Sands (2011) theorise that bereaved people are engaged in a search for meaning in practical, relational and existential spheres. Alfred Tennyson’s poem In Memoriam AHH is an example of meaning-making in response to loss. Tennyson’s great friend, Arthur Henry Hallam, engaged to his sister and aged just 22, died suddenly of a stroke. The death of a close friend in the vivid energy and electric promise of youth left Tennyson utterly devastated, and the poem is a representation of his evolving grief over two decades. These days, he may have been diagnosed with a Persistent Complex Bereavement Disorder or Major Depressive Disorder, medicated and counselled. In this long, meditative elegy, we see the changing faces of loss over time:

 … But who shall so forecast the years

And find in loss a gain to match?

Or reach a hand thro' time to catch

The far-off interest of tears? (Tennyson, 2008: np, Canto I Lines 49–52)

The insights expressed here herald the grief theories which, until relatively recently, understood grief as a negative experience to be endured and from which to recover. But if the challenges and uncertainties like those that arise during a viral pandemic may be cognitively reconstructed to make meaning, then this 1850 poem by Tennyson is clearly meaning-making, as Neimeyer defines it: “the attempt to reconstruct a world of meaning … the central process in the experience of grieving”. (Neimeyer, 2000: 83).

Whether prescriptive or immersive, literature can console, contribute to meaning-making and facilitate the development of empathy during the unpredictable and alarming times of COVID-19. When very little else may be known for sure, the words of the old masters may take us to the brink of meaning. But that’s the imaginative world. Back here in the real world we do what we can to prepare and respond, then wait to see how it plays out. For Social Workers, as for everyone, the world has irrevocably changed, and social policies, welfare safety nets and the very foundations of the way we interact with each other all altered to a disaster footing. Like literature, we were all on the brink. Falstaff was right. Give us life, indeed.