Working in the Reverberation of Après-Coup: Three Ecologies

Introduction

Adrienne Harris

We start with two quotes from Jean-Luc Nancy from this journal. First, “The creative brutality of the virus spreads as administrative brutality” (Nancy, 2020). Later in the essay, he elaborates “The viral magnifying glass enlarges the characteristics of our contradictions and of our limitations. It is a reality principle that collides with the pleasure principle. Death is its companion” (2020).

Setting Nancy’s ideas within the context of psychoanalytic work, theory and practice, I have come to think about the COVID-19  and the social unrest it has provoked and released guided by  two distinct but interactive concepts.  Above all, in this moment, we need to feel the deep engagement of the psychoanalytic and the socio- political, engaged in the very fiber of the clinical scene and the political, environmental surround.

To begin, I want to think within a system, an assemblage of Three Ecologies: the natural world, the social world, the mental world.  This concept, developed originally by Guattari (2000) has been most usefully harvested and imported into my understanding of our circumstances in this pandemic by Joseph Dodds (2019; 2020).  The Three Ecologies are interlocking systems, highly complex in their own right and in their modes of interaction and co-creation.  To understand where we are, we need all three and we need the degree of complexity this system affords us as we think, plan, act, run from, and struggle to confront our situation.

These three complex systems crossing levels of action, reflection, embodiment.  There is the natural world in which we are both victims and perpetrators, despoilers and desperate clinging souls.  There is the social circumstance and the powerful force of the State – for some as toxic as the virus.  And there is the mental ecology, including our focus here – psychoanalysis.  Here, we are interested in the stimulation of  unconscious fantasy,  of the remnants of our personal histories and in particular our histories of trauma.  These systems effect deeply how we function in complex EMERGENT encounters for all of us, singly, in analutic dyads and in groups.

Two psychoanalytic concepts seem crucial to understanding this moment, in its many layers and conflicts.  Above all, the pandemic and its structural and political offshoots and consequences is  an experience of apres-coup.  It is a moment, an experience in the present, that opens all the unmetabolized, untranslatables that any of us, all of us, have had to contain, rework and keep at bay over a lifetime.

Secondly, In the increasingly open-ended weeks and now months of working remotely and the increasing deepening of collective understanding of the meaning and impact and scope of ‘pandemic’, I have been struck by the resonance of early and deep experiences of terror and  helplessness, erupting in clinical material, in transference and countertransference, but idiosyncratic  for each individual.  I have understood this, not only through the lens of Laplanche (1999; 2017) and others’ ideas about apres-coup, but also in thinking through Winnicott (1971) about helplessness.  COVID-19 opens all of us to danger we have wrought to the environment and to the retaliatory capacity of the environment, the ‘environmental mother’, against which it seems we are helpless.

Alterations and radical transformations in the ‘frame’, broadly conceived, have been an immediate consequence of quarantines, massive and rapid spreads of disease, and in the United States, social dislocation and protest on a very wide scale.  We must think of the frame as functioning on a series of levels.  We must attend to: the broadly social circumstances in which daily life, sociality, work and public discourse are being radically transformed, beginning with the intrusion and management of the State which Nancy and others have noted.

But the analytic frame is transformed and besieged as well.  Following a number of analytic theorists Bleger, (1967), and more recently Goldberg (2018), and others, we can see the importance and complexity of the frame’s functions and management.  Goldberg has built on Bleger’s creative reading of the frame as both process and non-process and the container of regressive, easily fused and often psychotic aspects of character.  For Goldberg, is both inert and dynamic, capable  of framing and limiting, but also capable of enabling and sustaining powerful  collaborative shared experience, at conscious and unconscious levels.  The presence of the frame enables the analytic couple to sense things together, and often to have to work on the way that  potent and early disturbances, the bastions of psychic experience, are housed in the frame.

How is this to work when the social AND the analytic frame are so profoundly altered?

How do we craft a new discourse and clinical conversation in the light of massive alterations in the frame, precisely the aspect of the clinical experience that is expected to be sturdy and reliable, even as complex psychic experience is conducted through its spaces and sites?

Very soon in the public encounter with the Pandemic, we had to give up the idea that this global event rendered everyone helpless and at risk.  Within weeks of the government project of establishing quarantines and rules for social contact,  we have had to notice that this brutality – medical, social, and economic – has been falling on our most  vulnerable citizens.

It is not that there is nothing we can do.  There is much to do, if we dare or can insist, But  early, primary helplessness, as unconscious forces and forms in all of us, is activated in these particular moment/moments.  Inevitably, those early formative states can never be fully assimilated and so remain, to be triggered.  It is this vulnerability that, I suggest, renders us deeply susceptible to shame.

We have had to notice, from early on in this quarantine, that protection was actually a relative matter.  The intrusive  control and oppression of vulnerable workers – in food production and in hospital care – was intended to protect privilege and certainly this was understood as the effects of racism and class difference.  But this inequality of protection was not confirmed and transformed into the uprising and protest, peaceful and militant, until  the publicly witnessed and filmed murder of a black man by a police officer in Minneapolis.  It has been remarkable to notice how invisible structural racism has been and its presence now in public discourse may be one of the few but hopeful outcomes of the pandemic.

And, on the other hand, masks and social distancing can/are a matter of social responsibility.  Love for fellow citizens and responsibility (in a Levinasian sense) are entailed in masks and distance.  We have simultaneously fallen into the most terrible states of opposition, along lines of race and class AND still struggle to hold the potential for collective action that holds the only hope for transformation at many levels.  In America, we have perhaps never been at a crossroads with such momentous and different consequences.

Can Democracy be sustained/restored in the United States as we traverse the complex ecologies of this pandemic.  It was, perhaps, a rhetorical question. It is now the most serious issue Americans face and it appears in a political, social, economic, and ecological climate where there seem few guarantees of a good outcome.  This, five months into the effect and spread of the pandemic in the US, is the grave reality in which we all live and suffer.  As many have noticed, (Zizek, 2020) the sequence of events echoes and repeats the exact steps in which historically, militarized fascism comes into effect.  Racism has migrated to and with COVID-19.

In this essay, psychoanalysts examine the consequences and lived expression of this situation through an exploration of clinical work, with particular attention to the unique and complex relations to screens and a dramatic alteration of the frame, broadly conceived.  The frame and process of analytic work is altered – world-wide.  At the same time, we have to acknowledge the aspects of privilege and safety that have been maintained in psychoanalytic work.  Teletherapy and the variety of new structures for clinical work have protected many practitioners economically and medically.  It is significant that, in a national circumstance of unemployment and economic turmoil, many analysts have felt able and also in need of the traditional August vacation.  The contradictions of shared dangers and variable protections is striking.

Our focus in this essay is on the clinical situation: what it means to work in new frames, in new times of danger and often in a psychic/social/collective situation in which shame can lead to psychic collapse or transformation.  In the clinical presentations that follow, analysts chart the experience of shared trauma, the collective experience of the pandemic and the evocative personal and often early traumas that are activated in the process of apres coup.  The experience of the changed frame is complex and also unpredictable: sometimes alienating and thinned out, sometimes surprisingly intimate and revealing.  Isolation is leading to breakdown, to terrifying degrees of hopelessness and emptiness.  And, in certain situations, the space to be alone seems life-saving.

#########

Screened In

Fintan Boyle.

When we look at someone, we are seeing someone else.

Carolyn Forché.

Late April (the cruelest month I recall), far into the spring semester of 2020 I find myself uploading texts for my –of course now, zoom taught– cinema studies class.  It is a seminar.  We are studying European New Wave Cinema.  We are trying to align these post WW 11 cinemas with their recent history of fascism and slaughter across the European continent.  We are noticing the prevalence of surveillance, monitoring, systems for socially regulating populations in both the fascist moment and the era that followed.  Someone suggests we read Foucault’s panopticon essay.  Thus, it is Thursday evening and I am uploading a pdf. of the Panopticon essay for my students.  Doing so I realize that I had not remembered where he begins the essay…

“The following, according to an order published at the end of the

seventeenth century, were the measures to be taken when the plague

appeared in a town.

First, a strict spatial partitioning: the dosing of the town and its

outlying districts, a prohibition to leave the town on pain of death,

the killing of all stray animals; the division of the town into distinct

quarters, each governed by an intendant. Each street is placed under

the authority of a syndic, who keeps it under surveillance; if he

leaves the street, he will be condemned to death. On the appointed

day, ‘everyone is ordered to stay indoors: it is forbidden to leave

on pain of death.

He begins with the plague.

“On pain of death” we will need to revisit later per COVID-19 regulations.  But for now, I want to notice what is happening per “a strict spatial partitioning” in both my teaching and psychotherapy practices.  And when I am thinking of space it is both the space of the screen and the space of, what should I call it, geography? The geography of the treatment room we no longer share and the geography of distance, in some cases international distance, that separates myself and my patients.

Both practices, teaching and psychotherapy, are of course now being pursued through zoom, WhatsApp, FaceTime etc. (And that this sounds like product placement is not a happenstance to be ignored, but one to also be returned to later: it is a partitioning of social space through a, what should I call that, economic virus that demands of us a particular economic engagement?)

For Lacan the mirror inaugurates individuation and constitutes the first sense of one’s self through an image.  (Importantly, he cautions us, it is a misrecognition) With zoom the mirroring effect, the imaginary world of the video classroom, or therapy office encourages dis-individuation.  While teaching I scramble my eyes across the screen of fifteen faces to find the one who I want to talk to.  And more troublingly, as someone new enters the group that entry shuttles everyone else’s image around the screen.  My eyes scramble again to re-find my own image, which has shifted position.  A moment ago I was in top left of the screen now I am in second row toward the right.  In the group-zoom one finds that one spends ones image of oneself a little too freely.  My image all but literally runs away from me.

In my psychotherapy practice, I see individuals not groups.  I have chosen to contend with seeing on the screen two images, my patient and myself.  That is I have chosen not to hide the image of myself from myself and my patient, as is an option with zoom.  When I tried the option of concealing my image two things emerged.  First I found that I was automatically represented by an, albeit editable, rendering of my name: language stood in for me.  Secondly it felt that I was subjecting my patients to a voyeuristic gaze.  I could watch them but they could not watch me.  Now, with two images on the screen I am permanently aware of my imaged self.  As I watch, I am watched, by both my patient and myself.  Thus my own image communicates mnemonic hints about how to be myself.  My imaged body signals me about how to organize and regulate my actual bodily self.  It is somewhat like –but not the same as– the mimetic enactments that take place between the therapist and patient all the time in the room: he crosses his legs I cross mine.  Mirror and reflection keeping apace with one another until it is not clear which is which.

What was and is disturbing to me is exactly seeing myself? It is of course the uncanny resemblance, the, yes, familiar-unfamiliar toggle switch.  The procedure of working via zoom constitutes me in a series of less than comfortable recognitions of myself.  In a reversal, a mirroring might one say, of the Lacanian caution about misrecognition, with zoom I do not falsely see myself as whole and independent.  Instead I see myself as fragmented, partitioned in space, held at a distance,  performing me as a series of signals about how to perform me, and it is fundamentally disorganizing.

The most illustrative and unsettling experience in this regard was, perhaps fortunately (who knows?), not during a clinical use of zoom, but during a social use.  One of the oft promoted zoom cocktail hours with friends jolted me as I recognized the image of myself on the screen wearing a white T shirt emblazoned in red with the name “Jeremy Corbyn”, but Corbyn’s name was reversed, it was rendered in mirror writing: the symbolic itself comes undone in the mirror.  Political commentary aside, –for now– this is the uncanny nestled within the process of ones self-constitution through the imaginary portal of zoom.  The task of holding oneself coherently together, as one might expect to find oneself, perhaps as one imaginatively and proprioceptively organizes ones body, ones self across the space of the consulting room in a bricks and mortar office.

A lesson for us all, perhaps: today I read in the New York Times of an analyst who, throughout the lockdown, has commuted to his office, every day, dressed in his work suit to do telemedicine sessions with his patients.  The psychoanalytic frame –“a strict spatial partitioning” – it seems, if held fast, holds him fast in his sense of self-identity.  It is in fact the image of himself as a psychoanalyst that is displaced into the frame.  He puts on his suit, maintains his imago in a screened version of what, reality? It sounds like a sleight of hand, or a sleight of the eye and for him it apparently works.

For those of us who do not do this, who work from our homes the pandemic experience is a radical departure from the experience of being a therapist working in a dedicated office.  In that situation I see myself relationally, via the recognitions of the patient of what I say and how I move.  Via the mirroring, if you will, of gesture and posture, via the attunement of the other’s body and facial expression awaiting, for example, a moment to respond based upon unspoken visual cues from my gestures and posture.  Zoom offers an image of an other and myself on the screen.  I am now aware of all those expressions of mine not only proprioceptively but also visually.  Additionally zoom offers variously delays, lapses, loss of audio or video and loss of video focus.  All are interruptions, some momentary, some longer, that now constitute the therapeutic relationship, all are a loss of, or travestying of, relational cues.

All of these conditions, and more, constitute what we might call the rhetoric of the therapeutic screen.  (Remember, I teach cinema studies.) Camera positions shift the relationship of image to self and image to patient.  Someone who sits back far from the camera thus displaying their entire upper body feels very different from someone who is sitting much closer, leaning toward me and presenting themselves in, cinematically put, extreme close up.  How the camera of the phone, laptop etc. is angled torques my experience of the body I see.  Seeing a medium close up –cinema language again– up the nostrils of a patient is somehow alarming, intrusive, too much body.  In reverse, on the other side of the mirror, it must be the same for whoever is watching me.  In some case, with patients who will not sit still in front of the device but instead walk around with it in hand, the image of the patient slides out of frame, is cropped harshly or by turns invokes the canted camera angles of film noir.  This screen experience of the other is not equal to a body siting opposite me in the treatment room chair.  In that situation the body movements are attached to a corpus, not fragmented, they seem to flow in space, a space that I now realize, has a full three dimensionality to it.  There are no fracturing hard edges, no too-intimate close ups no emotionally surged camera angles.

The experience of each other in the treatment setting is also attached to a compilation of historically evolving conventions.  How the patient’s body presents is, in my office, determined to a very large extent by me, and how I have set up my office.  There is a set of chairs at a given distance, and over all there is a stable physical environment that will reliably and repeatedly be there as each different patient comes and goes.  The patients will each, allowing for differences of style, gender age etc., be dressed according to conventions that dictate how one dresses to travel in New York and attend a therapy session.  All of this speaks to the organizing or indeed, “ the strict partitioning of” therapeutic space that defined the conventions of being a therapist and a patient prior to the pandemic.

Now, on one hand space is not to so strictly partitioned.  My patients can be in any literal space.  I see patients in their bedrooms, kitchens, closets and sitting on park benches, (the latter two to achieve privacy).  I see them with cats, dogs, hamsters, children and partners making cameo appearances.  Determining conventions of dress have gone out the window.  On screen literal images emerge of how patients have chosen (consciously or not) to put themselves together to be seen by me.  The ‘frame’ of the analytic setting is replaced by the literal frame of the video rectangle, the latter breaks the former.  The patients now have a say in how the space is partitioned or framed.  If we want we could argue that this a democratizing of the space.  What is recognized, or per Lacan, misrecognized in these images, both in terms of the therapist’s perception and in terms of the self-image elaborated by the patient?

In an epoch defined by screen culture, even before the pandemic, the digitally native generation has a grasp on screen experience that people of my generation do not.

A significant portion of my practice is of college age students.  I work for a New York based University counseling service.  The students were all dispersed to their various homes across the country and the globe in March as the pandemic was belatedly recognized.  The student body, to protect its individual member’s bodies from contagion within a group was subjected to “a strict spatial partitioning”.  I now work via video link with students in New York but also, among other places, in California, Texas, Turkey, South Korea, China and South Africa.

Thus we meet each other through the strict rectangular spatial positioning of video

How does one read body signals, through the images of bodies only?

How does one read bodily resonance across a video link and five to fifteen thousand miles distance? (The distance for sure adds a psychic load to this therapist’s sense of availability, skill, attunement, ability to help, protect, care for –in short to the whole countertransference dynamic which feels messier by the day, I speculate, in reaction to the pandemic and the conditions it imposed upon my work)

One student was assigned to me by the counseling service a week after the students were dispersed.  He lives in Seoul South Korea.  I learn from the patient in a first zoom meeting replete with freezes, lost sound, and lost video projecting toward me a sometime disembodied voice, that he has a history, while in the United States of one psychiatric hospitalization and one suicide attempt.  I am alarmed.  If he were in New York and in need of hospitalization I would, I hope, be able to walk him, as I have done before with other patients to a hospital ER that I would choose based on history and knowledge of such spaces in New York.  Now?

The space of the screen obscures.  Corporeality is lost.  The video fails and the audio endures, A disembodied voice cruises through geographic space from Seoul to New York.  Later I search the same screen via Google earth to get a sense of where this patient is.  I click my way through the Itaewon neighborhood, home to many gay bars and clubs.  I know he spends time there.  I do not tell him of this Google earth search.  It feels, as it is, like surveillance, voyeurism.   I sort of know things about him –as in, I know what Itaewon looks like on a 15-inch laptop screen– that he does not know I know, and which I probably would not know, or even need to know, if we were meeting in my office.

But here is perhaps the panopticon effect.  He is a Young Seoulite.  By his own account he is of a generation and a national identity who live everything through the internet. Before the pandemic his life was significantly lived via Whatsap and Facetime.  That is, lived through the ocular, communication, cabal foisted upon us all by the pandemic.  It is all second nature to him. I know, for example, that he didn’t think twice about Googling me.  He wanted to see where in New York my office is. And thus know where we would be meeting in real space if that were ever the case.  He says it anchored the video meetings in a non-virtual world.  So does he expect me to Google him? “Visibility is a trap”, Foucault assures us.  The panopticon’s final wily power grab is that we will police ourselves simply because we are visible, visibility means that we may be being watched and so we behave as if we are being watched.

But then why do I need to know what Itaewon looks like anyway? I think it speaks to a reflexive failure of the screen experience.  A failure captured by my patient’s need to anchor “the video meetings in a non-virtual world”.  For me his verbal discourse, spliced onto his zoomed image, does not fully locate his bodily presence in space. If we were to meet in my office I could –using a different, older image making apparatus– imagine him after a session in the elevator, walking across campus, in the dining hall, in the dorms.  I could imagine him enveloped in familiar and meaning-creating spaces.  I could imagine him occupying some self-state that approximated to our shared words about him.  I could hold him as some species of internal object because his bodily presence in my office constituted that possibility of holding him internally.  Eerily the fluctuating televisual image does not provide that bodily presence.  The body is fundamentally absent.

And yet Googling him ups the anxiety ante.  Until I looked at Google earth I don’t think I realized how close Seoul is to the DMZ and North Korea.  Zoom in to as close up as is possible and you can see  border fortifications.  Google thus brings to mind the possibility, readily expressed by him, of his being drafted into the army.  Of his being deployed into contested geographical space to the north of Seoul, to wage combat, per a relentlessly militarized “spatial partitioning”, his body being put in very literal risk of  “pain of death”.  Or as he has also ruminated, refusing to deploy, and thus being jailed in a very, very “strict spatial partitioning”.  His body is fundamentally in danger.

Another patient, who disappeared from my view as the quarantining and dispersal of students occurred, reemerges in late April.  We establish a video connection.  This is different; we have a history of meeting in the office, bodies in attendance.  He is 24 years old, a Guatemalan immigrant, a DACA immigrant.  That is he arrived in this country as child, brought in illegally, and was granted leave to stay in an amnesty program initiated by the Obama administration. Trump has sought on multiple occasions to eliminate the DACA program.  The geo-political space this patient may occupy is uncertain, contested.  Again the sense of space being drastically surveiled and policed is present.  This patient dare not leave the country for fear he will never be able to return to the country that has been his home since one month of age.  For this patient there may be no such thing as national or political space.  He currently lives quarantined in a small apartment on a block opposite Columbia Presbyterian Hospital.  By video he shows me the view out his window (not unlike, it occurs to me, the rectangular segmentation of space Foucault describes as that of the panopticon’s windows).  On my screen it looks like you could reach out and touch the hospital.  Refrigerator trucks, he tells me, are parked down the block.  That simple, brusquely delivered statement, is a translation of his all-surrounding anxiety about space and death.

I realize that much of what I have been thinking about in the preceding words has been the segmentation of vast geographical space versus the loss of intimate office space.  But I also come to realize that the precise geographical space one occupies in relation to the pandemic, and its effects, also has a direct correlation on ones psychological ‘space’.  Each partitioned space, virtual or actual, launches a series of misrecognitions, each space inaugurates a series of identifications.  Thus the history of partitioned, militarized and prohibited space in South Korea, and the space of immigration between Latin America and the US is correlative to, is folded into, the global space of the pandemic and the private spaces of quarantine.

#####

Screened Out

William Buse

I first heard that therapists were resorting to teletherapy, virtual psychotherapy, or technologically mediated psychotherapy (I still do not know what to name it) from a colleague.  My resistance gave way to fearful acceptance.  All the patients I regularly meet took the offer for this new form of treatment (distance therapy?).  All except one.  Nico left an unequivocal message on my voice mail stating he would not continue with me until we could meet in person.  In my unthinking haste to facilitate the transition of my entire practice population onto an altered representational platform I barely had time to register the meaning of this sole dissent.  Nico’s decision inadvertently reflected the social dimension of a practice that sustained itself, at least partly, through reflexive, ritual compliance and reliance.  For most, the generalized discomfort with the ensuing disruption was indistinguishable from the anxiety over contracting a potentially fatal illness. Without a choice in the matter everyone gave it a go, except Nico.

Nico, too, was terrified of exposure, but not to the virus.  He was terrified by the screen that would now mediate our connection (e.g. WhatsApp, Zoom, FaceTime, Skype, etc.).  Nico knew that the screen presented a challenge to his ability to both present himself and relate to, or even identify with, my translated representation of him.  The fear in his voice when he begged off the offer to phone it in betrayed a nearly phobic avoidance.  It was as though he might be found out.  But why?  From a distance, and without his participation, I continued to be haunted by him and his withdrawal.

Nico is a very big, morbidly obese man, born and raised in a Mediterranean country, who communicates as much with his whole body as his vocal cords.  Approximately 40 years old, he works in Manhattan as a chef.  He presides over a very demanding restaurant kitchen with several assistants where he is simultaneously over-stressed and grateful for the daily, unrelenting challenge that drowns out the voices in his head.

From childhood, Nico wrestled with internal voices, invariably unkind and critical, that never leave him in peace.  As an adult, he sought to quiet them with cocaine, alcohol, prostitutes, and generally dangerous living.  Now he’s sober and attends Alcoholics Anonymous meetings whose combination of slogans and social reinforcement are barely holding him together.  He randomly met a colleague of mine in Riverside Park and, appealing to him for relief, procured my name. He had never been in treatment before and was desperate.

Nico anxiously entered our first session seeming as though he were about to explode.  He could not sit still or stop moving.  Through his heavy accent I got the impression that he was quite self-aware, or at least in the way that 12-step patients in ‘recovery’ can seem.  Paramount in his history was a father that he described as ‘crazy.’  Apparently, his father also heard voices, operated in another reality, and seemed poorly related, if even accessible, to Nico in childhood.  Understandably, Nico was concerned that he was just a chip off the old block.

When Nico pressed for immediate relief from his debilitating, paranoid anxiety I suggested a medication consult which he rejected.  He was, after all, in recovery from substances and deeply suspicious of any chemical solution.  I decided to conduct a hypnotic session with him in which I would simply attempt (and gauge his ability) to have him relax.  The experience was unusual; he felt as though I was continuously moving, now close, then far away, throughout the induction, which frightened him.  He left a message after this session to cancel all future therapy but after a few weeks called me back, again quite desperate, asking to continue.  His staff had filed complaints against him, his only child said he could not stand to be in the same room with him, and his AA cohort pitied him from a distance.  What could I do for him?

Nico required a partition, a divide between the real and the imaginary that he could not construct himself.  He sought a reliable screen that enabled a notion or experience of himself as distinct from the non-him, from his father, from the voices. I believe that in our sessions he was searching for that screen in my body, not in anything I said.  If in session I was calm, he was calm; if I was distressed, so was he.  Maybe someday I would be his trusted mirror in which cognition and recognition occur, but for now I was less seen then felt as the auxiliary parasympathetic affective system he appropriated, borrowing my somatic ability to control myself and self-regulate in his presence.  My body yielded somatic cues as to how I was able to exist as an autonomous ‘I’ amidst the roaring stimulation from the past and the present, from inner and outer space.

Bertram Lewin (1973) postulated the presence of a screen as the developmental baseline for all human interaction: “The dream screen, as I define it, is the surface onto which a dream appears to be projected.  It is the blank background, present in the dream though not necessarily seen, and the visually perceived action in ordinary dream contents takes place on it or before it” (p. 88).  Lewin goes on to trace the infantile discovery of the screen as embodied in the mother’s breast.  This would seem to be a prelude to symbolic activity, in much the same way as a white page enables the print you are now reading.

Beyond being a prerequisite for individual symbolic activity, the screen is intrinsically related to what it means to be human.  “There can never have been a moment when specularity was not at least in part constitutive of human subjectivity…And ever since the inception of cave paintings, it has been via images that we see and are seen” (Silverman, 1996: 195).

Not only is the specularity of the screen ubiquitous, but it invariably holds a double function as both revealing and partitioning.  Moreover, this dual property of the screen is often associated, in the anthropological imagination, with the site of the cave (as distinct from the breast).  The suggestion of a prehistoric prototype for the screen, that both reveals and partitions, predates even Plato’s cave with its spectacular allegory dividing real and ideal forms.

It is in the Neolithic paintings of the Lascaux caves that Bataille (1955) locates the original point at which the screen emerges as the intermediary partition between animals and humans.  Some speculation is offered as to how these paintings could have developed accidentally from the protohumans (Cro-Magnon) mimetically copying bears with whom they alternately shared the caves and who left scratches on the walls.  These primitive marks developed into paintings that possibly coincided with, or supported, the development of language.  Such nascent classificatory activities led to a distinction between human and animal, a highly ambivalent and tentative distinction that we can imagine, with Bataille, was experienced perhaps more as a loss than an achievement. v(In the same way, analogously, that the elaboration of a dream relayed through secondary process narrative never quite recaptures the immediacy of primary process experience.)

Bataille (1992)  speaks of the cave paintings as a kind of play, much like eroticism, and the striking degree to which this play (over thousands of years) was linked to an awareness of death that further reinforced the arbitrary division of animal and human. “The image of man and/as beast exists as an irreconcilable combination of eroticism and death, identification and displacement, affirmation and negation” (Kendall, 2005: 31).  But, Bataille warns, the inner connection to the animal and the animal life would never be completely lost and would forever haunt humans from within: “The definition of the animal as a thing has become a basic human given.  The animal has lost its status as man’s fellow creature, and man, perceiving the animality in himself, regards it as a defect” (Bataille, 1992a: 39).  Rules – of grammar, kinship, religion, etc. – would be constructed as the bulwark against any threat of a return.

Psychologically speaking, Lacan cites the ‘Nom/Non’ of the father as the quintessential rule that facilitates admission into the Symbolic realm.  Observing this single (metaphorical) law, representing eons of cultural development in itself, is required for the child to join society and leave dreams of merger (incest) derivative of animality behind (the foundational importance of the incest taboo for the rise of human culture is famously asserted by Levi-Strauss, 1969).  For the rest of our lives, nagging anxiety dreams of arriving for a test or a performance completely unprepared will linger as relics of the fear of not passing the test posed by the ‘Nom/Non.’  But what happens when the test is administered by a psychotic father?

Nico was living as an imposter.  He never took the test, or he tried and failed.  He faked an ability to decipher signification and, like so many psychotically paranoid individuals, and was terrified of being found out and persecuted.  How did he pass all these years before I met him? He was expert in mimetically matching the tenor, tone, inflexion, accent of each person he met – and of hiding/tolerating the voices in his head.  Until now.

Nico’s creative, albeit furtive, blend of tactility, mimesis, and ‘as if’ served him well in the kitchen where he apprenticed and taught others, far from the observation of hungry diners waiting outside.  Now he sits at home, eating, sleeping, masturbating, seeking distraction in silence, defenseless against the voices that disrupt “the continuum that distinguishes the animal realm” (Richman, 2018: 157, author’s emphasis).

Nico is off our grid, screened out, unrepresentable and invisible to those of us who made the passage, via the new Nom/Non, into the virtual cave, protected behind our screens against the contagion of inter-species communion .

#########

Screen Remedies:  Self-Emergence in a Gender Nonconforming Adolescent During COVID-19

Deborah Liner, Ph.D.

Introduction

Conducting psychoanalytic psychotherapy during the time of COVID-19 constitutes a radical alteration not only in the lives of the analyst and analysand, but in the process of treatment as well.  For my patient, Casey, a gender nonconforming adolescent, the isolation and aloneness created by the pandemic led to moments that were paradoxical; times in which he felt bereft and disoriented at the loss of social contact and those in which he experienced himself flourishing in his solitude.   This paradox has been there for us all during these fraught times, one in which the imposed isolation can be experienced as enhancing and liberating or as stifling, dispiriting and disruptive.

In presenting the psychotherapy of Casey, I hope to demonstrate that during a specific phase of the treatment, the new parameters resulting from the restrictions of life under COVID-19 may have contributed to a freeing up of the conditions for “becoming” and creative self-discovery.   The changes in the treatment setting centered upon miles of physical distance between analyst and analysand and the screen as mediating the therapeutic engagement.  The cinematic effect of the screen appeared to infuse the transference and countertransference with a richness and aliveness, states of playing and reverie, that was both surprising and welcomed by both Casey and myself.  One framework in which to think about the emergence of self that was evidenced in the treatment is in terms of what Ogden (2019) identifies as the ontological in psychoanalysis, or the co-creation within the analytic dyad of a patient’s “coming into being.”  The ontological can be as important or powerful as the epistemological, which is that dimension of psychoanalysis that is focused on “knowing” and involves arriving at understandings of previously unconscious thoughts, feelings or bodily experiences (Ogden, 2019).

Beginning Psychotherapy

Casey is a 17-year-old who was assigned male at birth but identifies as gender neutral.  I will use the pronouns he/him/his because that is how Casey refers to himself.  He explains:  “I just am who I am – I guess you’d call it gender fluid, gender neutral.  I’m ok with he/him/his.  Maybe I’m in denial of something, but I really don’t care what people call me.”  Much about Casey’s gender identity and sexuality has yet to be explored.  But it does appear that something vital has been eclipsed; something closed down and something of excess that could no longer be held in, given the crisis that ultimately brought Casey into therapy.

Casey came to see me because of a “falling-out” he had with his friend group at the specialized technical high school he attends.  At one point prior to treatment, Casey made a remark that implied his sexual attraction and desire for another member of the friend group.  His hint of desire seemed to signify a dangerous blurring of boundaries of sexual orientation and gender within the group – an open expression apparently that had broken an unspoken code and was taken as an unforgiveable offense.  There was no opportunity for repair.  Casey was expelled from the friend group and shunned.  Retreating in shame, he avoided social contact at school, hiding behind a feigned obsession with coding.

The pain of his imposed isolation was unbearable.  Casey was plagued with suicidal ideation, primarily as he prepared for sleep, and, at age 16, he returned to the parental bed for protection against the onslaught of self-attacking thoughts. He could not imagine moving on socially as this was the only LGBTQ friend group in the school.  Casey could not fathom how he would survive two full years of aloneness in high school before finally escaping to college.

Casey exhibited an extraordinary commitment to the difficult work that his psychotherapy entailed.  Over the course of a year, his suicidal ideation and self-attack gave way to a greater ease with difference and understanding of his need to individuate.  Looking back on this painful episode, Casey felt relief in being free of the constraints of the previous friend group and found that he was able to form new friendships that were more accepting and open to intellectual and personal questioning.  His need for greater openness in his relationships may have actually propelled his estrangement from the friend group in the first place.

Then Comes COVID-19 And On-line Screen Sessions

After five or six hours of video classes, Casey enters our Zoom therapy room, squinting at the screen.  He sits back, relaxes his face and gives a sigh and a nod “yes” after I comment: “You’ve had a lot of screen time already.  Are you ok to meet?”  Our sessions address his most immediate concern, that of his longstanding problems with procrastination in getting schoolwork done.  Clearly, the removal of the structure and social routines provided by attending school has left Casey drifting in the timelessness of his bedroom.  His grades are beginning to drop.  We work on creating structure at home and venture through issues of perfectionism and paralyzing self-critique that interfere with his completion of school assignments.

At the same time that his ability to focus on schoolwork is collapsing, in the aloneness of his bedroom, another part of Casey appears to be flourishing.  He becomes exuberant when describing the impact of social isolation on his process of self-discovery, the freedom of not having to manage the expectations and judgments inherent within each interpersonal encounter at high school.  Casey elaborates: “How great it is to be in this room and have the total freedom to let my mind go and no constraints on how I have to present myself.  I’m free of questioning of how am I coming off, what are they thinking of me, how are they seeing me.  In high school, you have a brand you have to live up to.  Here, I am able to drop all pretense.  You know how you have to contract something in yourself and expand something else to fit into the social structure?  Like adjusting your shape to fit in, like a piece of a jigsaw puzzle?  I’ve dropped all of that.  It’s now more like circles all over the place, some overlapping, some in separate locations. Everything interests me now.  “And is gender a part of this?” I ask.  Casey responds: “I don’t think of being one thing or the other.  I’ve stopped judging things.”

Casey is talking about the myriad social pressures he experiences at school, but gender conformity is clearly on his mind.  When there is gender variance or fluidity, these pressures are more than fitting into a social structure.  They involve inevitable messages that he, Casey is somehow not right, not the right person gender wise.  In his closed room of quarantine, Casey is less at the mercy of such cultural and interpersonal interpellations and is freer to explore his bodily and gender experiences.  I reflect on the visual metaphors that he is using to describe his self-experience: contracting and expanding puzzle pieces; circles, some dispersed and some overlapping.  Casey doesn’t want to identify as male or female and does not see these as separate categories.  I envision an abstract expressionist piece of art, something like a Caldor painting, depicting circles, spheres and irregular rounded shapes, seemingly in movement and interacting with one another.  Such a painting would reflect something uniquely personal to the artist and evoke something equally personal in the viewer.

Meeting with me virtually, sitting in his bedroom, Casey is relaxed.  Previously, when arriving at my office after school, Casey often looked as if he was hiding under his hoodie, his long wavy hair tied tightly back in a ponytail.  Now, on screen, I see Casey with long hair flowing gently over his shoulders.  There is an ease and freedom to his movements. Casey claims that external judgment does not enter this bedroom space.

Relieved of the internal and external pressures of interacting with peers,

Casey’s anxiety attaches to his quest for identity and self-definition in the upcoming college application process.  After several weeks of feeling immobilized and incapable of developing a list of colleges to which he should apply, Casey is thrilled to have identified what he wants in his college experience: “I must attend a college that allows me to study drawing and design as well as coding and computer technology, one that will truly support my bringing together art and tech.  I cannot go to a college that requires committing to just one modality.”  Integration, a melding of various forms of thinking and expression, is the key to Casey’s puzzle.

Casey’s choice of academic pursuit appears to incorporate identifications with both parents. His mother manages a computer software company and his father, trained as a graphic artist, has been the “stay home” parent.  I wonder, what about his parents’ nontraditional gender roles are reflected in his construction of gender fluidity (Harris, 2009)?  What about each parent’s past and unconscious stirrings and their marital conflict has been enigmatically communicated (Laplanche, 1999) to Casey that he is now tasked with translating and assimilating within himself?

Within the relative safety and sheltering of his bedroom and the receptivity and witnessing of our therapy relationship, this particular period of aloneness has been enriching for Casey in terms of his self-discovery (Winnicott, 1958, 1971a).  It is quite a contrast to the toxicity of the isolation imposed by his friend group last year.  Freedom from intrusion by cultural norms and peer pressures has allowed Casey to experience the sort of play that Winnicott (1971b) describes as central to a person connecting with a more authentic, true self; and for the type of reverie and dreaming that Bion (1962) and Odgen (1997, 2007) identify as bringing into representation experiences of self that are unencumbered by social impingement and imperative.

The space created by the unique parameters of the therapy during the time of COVID-19; that is, being together while simultaneously miles apart and our interactions mediated through images emanating from flat screens, may be freeing for Casey as well.  Yet, to me, much is lost in this new modality from in-person sessions.  For example, the impact of nuanced bodily movements and expressed emotion, the transference evocations of the analyst’s office and settling down onto a chair or couch, the space for reverie traveling to and from sessions – mostly this has evaporated.  On the other hand, the two-dimensional relating between Casey and me pulls for different imaginative, cinematic processes and new, fluid expressions of transference and countertransference phenomena, identifications and states of “being.”

Ogden (2019) differentiates between what he calls epistemological psychoanalysis (pertaining to knowing and understanding) and ontological psychoanalysis (focusing on being and becoming), the former having its beginnings with Freud and Klein, the latter with Winnicott and Bion.  At this phase of Casey’s psychotherapy, “meeting” on Zoom seems to have facilitated his growth in terms of his ontological emergence of self, his becoming.  My two-dimensional screen representation may be less of an impingement upon Casey, allowing more potential for him to enter transitional space in my presence (Winnicott, 1971c) and engage in his own self-exploratory reverie (Bion, 1967; Ogden, 1997).  In Laplanchian terms, our actual physical separation may facilitate an opening, a “hollow” within Casey’s psyche, allowing space for translation and assimilation of unintegrated desires and identifications (Laplanche, 2015, 1999).  Concerning Casey’s “playing” with gender, I suspect that in our in-person sessions, my gender difference was more visible to him and therefore more intrusive.  I wonder if my flat screen image, showing my body from only the waist up and my curly brown hair uncharacteristically touching my shoulders, now resembling his, is seemingly less differentiated in terms of gender and thus more accessible for mirroring, affirmation and psychoanalytic companioning (Grossmark, 2018).

Over the course of our Zoom sessions, I feel myself fluctuating between states of discomfort and ease.  I see my image at the top of the screen looking back at me.  My curly hair, which I typically keep short and styled to maintain a professional image, is touching my shoulders now.  In my reverie, this image reminds me of that wild, carefree, what I considered my Janis Joplin look that I took with me to college.  This “look” is a product of my own social distancing: hair salons are closed and I can’t possibly cut my hair myself!  I wonder: “Will my patients be disrupted or disturbed by my more shaggy appearance?”

Then, I let go of the external gaze.  I find that I am taking delight in the screen image of my unrestrained hair appearing next to that of Casey, our meandering locks interweaving in this multimedia format of sound, movement, expression and dialogue, defying some societal statement of who each of us should be.  My teenage self and Casey’s meet and come into a state of play with one another; a mutuality that is part of the ontological in psychoanalysis, the process of creative self-discovery.

In retrospect, I consider the appearance of Janis Joplin in my reverie as the emergence of Ogden’s (1994) analytic third, a co-created subject within the analytic field that structures the relationship and symbolizes meanings within the dyad.  I see this third, mediated through screen imagery, as speaking to the exuberance of adolescent becoming as well as the treacheries of this phase of development.  Perhaps my fleeting anxiety about my “untamed” screen image is an après coup experience (Laplanche, 2017), one in which my past adolescent process of self-emergence has been evoked.  I contemplate both the excitement and terror of adolescent self-discovery; the gathering in and letting go of identifications; the travails of longing, loss and frustration in young love; the articulation of aspirations and, the anticipation of the loss of one’s childhood.  I link these imaginings to Casey’s recent experiences of delight and distress.

In between sessions, I continue to play with the theme of Janis Joplin, in search of what else it may bring to my work with Casey.  I take walks and listen through my headphones to the Janis Joplin station on Pandora.  I haven’t heard her songs in decades.  In my youth, I associated Joplin with the counterculture and free spirit that I was experimenting with at the time.  But now I am acutely aware of the anguish over loneliness and yearning for love that is expressed in her blues lyrics and melodies.  I resonate to Joplin’s recordings with the pain of losses in my own life, particularly the recent death, early in this COVID period, of a very close family member.

What does this melancholy evoked by Janis Joplin’s music have to do with Casey and our work together?  I think of the loss of his friend group and his reactive withdrawal from outward expression of sexual desire.  I am reminded of his speaking about his “possible denial” with regard to the pronouns he uses or allows.  I anticipate there will be some loss to be faced as Casey engages more deeply with his feelings about the pronouns he was assigned at birth.  As he leaves his family home and the parental bed, I imagine he will have to sort through and shed identifications that belong to his parents but no longer feel relevant to his own becoming.   With extended quarantine, the prolonged loss of in-person contact with peers will certainly take its toll upon Casey’s emergence, particularly in terms of gender and sexuality.  Finally, Casey and I have the on-going task of exploring what has been lost in our relationship through our physical isolation from one another.  I expect that the paradoxical experiences of aloneness, those fostering and inhibiting Casey’s process of becoming, will be a continued theme of our psychotherapy work during this time of COVID quarantine and afterwards as well.

Casey and I have only begun to navigate his inner “circles” – separate and overlapping.  I do not know how long we will have to work together via Zoom.  It may be until Casey goes off to college.  Perhaps the image of Janis Joplin and the sounds of her riveting blues evoked within the analytic field will help bring Casey’s more obscure shapes to light, those pleasures, yearnings and losses that have yet to be represented for our mutual consideration upon our separate and distant screens.

###########

 The Zoom Mirror

Lorraine Caputo

Since mid-March of the Covid-19 quarantine in New York city, I have seen all of my patients via Zoom where we face each other in a space extremely hard to define.  I ask myself, are we in the cloud together or in an “as-if world” like the movies, waiting to go back to the real world of my office? A not-us experience, the “us” being how we knew ourselves together in a 3-dimensional space, as we now inhabit –or do not inhabit– our bodies as screen borne images.   How does my gaze change the therapeutic relationship when I am gazing through layers of cyberspace?  How are we both changed by this technological gaze? How do we account for, in the treatment matrix, the experience of watching ourselves and our patients on the screen, as our patients watch us and themselves simultaneously on their screen?  How distracting or enhancing is this added dimension of physical self-awareness in the mirror for both patient and therapist?  Freud’s quip:   “I cannot let myself be stared at for eight hours daily”  (https://www.bbc.co.uk/ahistoryoftheworld/objects/cC0TV0KISWGsw1N0fERYRg#:~:text, retrieved 7/17/20) resonates, but the option of deleting myself from my side of the screen felt “un-relational” and voyeuristic.

In my office, I am not confronted with my physical self as I am in a virtual session.  I am generally not thinking about how badly my hair looks, my double chin or the scars on my face, specifically on my eyelid, my forehead and my upper lip and cheek, but now with Zoom I am reminded vividly every hour of my flaws.  While falling in love with the actors, my patients, on my screen, I am falling out of love with myself.  Perhaps this countertransferential field I am projecting has allowed them to project their own sad stories of broken hearts and feelings of being misbegotten.    In unexpected ways, my patients are experiencing this exposure to their reflections in startling ways that mirror developmental issues and relational and attachment issues.

In “Beyond the Reflection, The Role of the Mirror Paradigm in Clinical Practice”, Paulina Kernberg, MD, chronicles her research on the use of the mirror with children and adolescents, particularly adolescents who have been hospitalized for psychiatric disorders.  Her chapter Mirror as Mother reviews the literature on attachment and development as it relates to infants use of mirrors and their use of mother as mirror.   Mirrors offer infants a perfect “contingency” of themselves; the mirror reflects them and they learn about their own “unique characteristics” (Kernberg,  2006, p. 32) and recognize that others exist separately in their own uniqueness.    She references Lacan (1951) who describes the integrative function of the mirror…that can be understood as symbolic mother.”   Lacan described “mirroring as reflecting back the illusion of sameness” … almost always found in the dual relationship wherein one seeks to be affirmed as idealized by the other; to be found in the consciousness of the other just as one is found in one’s narcissistic consciousness” (Kernberg 2006, p. xvii).   Lacan’s developmental stages of mirroring begin with the sense of a “fragmented body” emerging to an “integrated body” (Kernberg, 2006, p. xix). In her research with adolescents and mirrors she concluded that “…the mirror experiences seem to facilitate the emergence of dissociated states which in turn result in transient changes in perception.”   In the zoom space my patients and I experience our bodies and psyches in fragments which in turn has allowed dissociated parts and new self-perceptions to emerge.  In some of the vignettes below I write about these haunted perceptions of self embedded in attachment relationships with important others.  In many of the treatments there is a movement from a sense of fragmentation to integration as time in cyberspace becomes part of the relationship.

Winnicott says “In individual emotional development the precursor of the mirror is the mother’s face.”  He gives homage to Lacan but thinks about the face of the mother differently than Lacan.   Winnicott believes the mother reflects back to the child the infant’s own self, much in the way therapists work with patients:  “”Even when our patients do not get cured, they are grateful for us seeing them as they are…”(Winnicott, 1971).   My question is whether our patients fragmented selves can still feel held, seen and contained by video teleconferencing in the same way they can in our offices.  In some of the vignettes below we see how both therapist and patient struggle to find integration in the mirroring aspects of video conferencing and how the zoom mirror can complicate the therapist’s role of reflecting and holding.

Harris and Tylim (2018) facilitate a discussion of the frame in their book “Reconsidering the Moveable Frame in Psychoanalysis”.   One chapter, by Luca Caldironi is called Psychoanalysis and Cyberspace: shifting frames and floating bodies,” refers to the “implicit intentionality” of our work which is to “explore and study, with every available tool, the comprehension of the deepest aspects of human nature” (Caldironi, p. 234)  and reminds us that ‘shifting frames and floating bodies” were always a part of Psychoanalysis’ research (Caldironi, p. 233).  In this time of virtual sessions, we must examine whether Zoom  allows us to maintain the basic intentionality of our work:  to allow the patient to explore their unconscious conflicts and  for an intersubjective experience for both patient and therapist. Even in cyberspace (DiChiara in Caldironi in Harris & Tylim 1971, p. 49): “the setting is what allows the patient to actualize a range of experiences related to his/her unconscious, childhood, personal conflicts, and where actualizing certain experiences means experiencing transference( DiChiara, 1971, p.49).”  In my experience, the Zoom setting has not failed to deepen the work but has rather unearthed unexpected findings because of the setting’s own peculiar nature.   It has also introduced Apres Coup moments as this macro trauma  activates earlier traumas for therapist and patient.   In our effort to provide our patients with the constancy they have known in our offices via teleconferencing platforms, the transformations or distortions of the frame may play an unexpected role.

An almost 11-year-old, primps her hair in the Zoom mirror, holds it on top of her head, to the side, or does it look better down? In that session her reflection and my awareness of this developmental change in her allowed for the emergence of her fears of menstruation, fears of becoming a teenager (“who will we, me and my friends, be?”) and her precarious sense of self.  The unpredictability of menstruation and now the virus has left her with more anxiety and uncertainty about her sense of agency.

A 16-year-old boy who struggles with obesity and body image,  sees his large hands in the screen ; he feels both proud of his large feet and hands and how he used that prowess in 8^th grade to “body bully” others on the basketball court.  Seeing his large hands in the screen, in my presence, leads to the recognition that he was channeling his anger at his parents’ divorce in 8^th grade.

Two young women in my practice  turn off their videos suddenly because they did not want to be seen.  The youngest, age 13, had revealed a sexual trauma to me before the quarantine began.  Because I had to discuss this event with her parents she was angry at me and punished me by going dark.  She has learned to hide in her large family where she her needs are not recognized.   She now hides her pain from me, playing out her role in her family.  The other young woman is in her early 20s and turns the video off when she has an outbreak of cystic acne.  The acne is intertwined with her mother’s distorted reactions to my patient’s acne as a teenager, actually breaking my patient’s pimples with a sharp object.  She breaks her own pimples now and is full of self-loathing.   Growing up she felt alone, neglected and without anyone to reflect back to her who she really was, leaving her with the projections of her mother’s wish for her to be a performer or a star the darkened screen of Zoom reflected back to me her fear and ambivalence of being seen, her deep shame about her physical self.   As time goes on she begins to pull back the dark screen to allow me to see her face.  This enactment led to a deeper exploration of her self-esteem.

A 72- year- old patient seen twice per week, a child of holocaust survivors, with a difficult history of complex relational trauma, the loss of a successful career, two psychiatric hospitalizations with ECT has had much trepidation about zoom therapy.

In our first Zoom session she is sitting in her bedroom in a satin chemise.  She is normally dressed as if she is going to work, accessorized, and made up and wearing a wig due to Alopecia.  She said she was late getting into the session to put on her wig: “I know you know me for years, but I couldn’t have you see me without my wig.”   She begins rocking, something she has not done for years, an indicator of the level of anxiety she is experiencing, it comforts her, but she is often unaware she is doing it.  She says she began rocking to soothe herself in high school.   She looks so fragile in the frame in front of me,  like Blanche DuBois from A Street Car Named Desire.

Her self-loathing and fragmentation emerge as she sees her imperfections up close while in this virtual world.  She spends some of the sessions complaining of her wrinkles, and touches her face in the mirror:  her neck, the edges of her eyes.  It feels like she is reassuring herself that she still exists.  She tells me I have no wrinkles.  “I have other imperfections!” I say, “We can both see our imperfections” in this world of zoom.  For the first time ever, she talks about paying for plastic surgery.   In another moment she says she can never have zoom sessions with her psychiatrist: “it is too close; it is too close!  He cannot see me this way, my arms are wrinkled, and my skin is hanging. “ Her perception of herself hinges on others’  objectification of her body.  She tells me “I come from a background where I had to be vain.  My mother was so beautiful, everyone wanted her.  The beatings she gave me made me feel ugly.  I came out of my house feeling so ugly.  I felt so unwanted.  I used to feel so ugly I thought I had to cross the street when other people were walking on the same side of the street as me. I couldn’t stand for them to look at me and feared they would beat me up.”

Her desire to be perfect and beautiful play itself out through excessive spending on clothing, wigs and bags; while working she needed to dress for her position as a foreign desk producer for a morning news show.  She continues to dress this way, as if she has somewhere to go even though she has not worked in more than 20 years.  Her mother would give her money for clothing when she was working.  Yet my patient never felt and still does not feel her beauty and attractiveness.

Covid has triggered memories of her work as a foreign desk producer.   She remembers working the night shift when a terrifying and destructive international event occurred.  In her memory she is the competent and empathic producer who helps calm the junior foreign reporter in that country to handle and report on the information to be broadcast.   “He was falling apart; I had to hold his hand and help him to stay calm to report the news we needed.”   She was unable to remain centered and calm after the destruction she experienced at the hands of an abusive mother whose own center was destroyed by the experience and horrors of living in a Nazi concentration camp.   In the newsroom she could be integrated and competent in the face of the world’s chaos and lack of a witnessing third where she became another person’s third and a third for the world atrocities.  (Gerson, S. 2009).  She now feels helpless in the face of the brutal reality of the COVID-19 world we live in.  Her fears of isolation and the aging process she sees in the zoom mirror have intensified during this time.   The challenge of isolation and of confronting the aging process are leading to  fragmentation for her.  I am her third even though I am through the looking glass.  There are multiple Apres Coups occurring as she remembers old traumas and times of competency as she faces the isolation and quarantine precipitated by COVID-19 virus.   At least two people in her building of older adults have died, but she remains calm in her descriptions of their deaths and initially had not remembered to tell me.

At the beginning of the quarantine, she is panicked and angry about the restrictions.  She lives in a HUD residential building for older and disabled adults.  They require residents to sign in and out at the front desk and share their destination.  She is particularly enraged as this prevents her from going to NY to see the hairdresser who cleans and styles her wig.  She is used to going out to shop for food every few days, small trips to the grocery store.  I associate to her mother and father being forced into a concentration camp, denied food, denied their freedoms, almost denied their right to live because they are Jewish.  I recognize her fears of the potential for state brutality. This association is calming as it integrates the past and present trauma, the apres coup of this moment.

In more recent sessions she is dressed more like herself, with makeup and with a business-like cardigan.  She looks like she is going somewhere.  Yet, her ability to go anywhere is restricted.  I feel she will endanger herself by going out, but she will not hire a shopper.  She tells me sheepishly in the next session she did go to the grocery store, standing in a long line, six feet apart.  She is rebelliously trying to go out but has taken it seriously as I and her family members ask her to stay home as much as possible.  She does not like to think of herself as “Old” and in a high- risk group.

She oscillates between closeness and defensiveness with her older sister from whom she was separated at age nine in Israel when her sister went to live on a kibbutz.  She tells me she almost cried the night before because she did not feel loved by her sister, she was envious of her sister’s relationship to a female friend.  I tell my patient that nothing can get in the way of her bond with her sister and their shared history.  While her self-states are changing rapidly in these sessions, she can reintegrate by the end of a session.  She makes a very impassioned statement this past week about how much loss is tied up in not being able to see me in person.  I am thinking we will meet at a park when the heat has subsided and sit on a long bench, at least 6 feet apart, masks on, where we can at least see each other in person, but when I bring this up, she says, it would not be a comfortable setting for her, it would be too “close”.