Patterns of pain: what Covid-19 can teach us about how to be human
We can expect psychological difficulties to follow as we come out of lockdown. But we have an opportunity to remake our relationship with our bodies, and the social body we belong to.
By Susie Orbach
When lockdown started, I was confused by bodies on television. Why weren’t they socially distancing? Didn’t they know not to be so close? The injunction to be separate was unfamiliar and irregular, and for me, self-isolating alone, following this government directive was peculiar. It made watching dramas and programmes produced under normal filming conditions feel jarring.
Seven weeks in, the disjuncture has passed. I, like all of us, am accommodating to multiple corporeal realities: bodies alone, bodies distant, bodies in the park to be avoided, bodies of disobedient youths hanging out in groups, bodies in lines outside shops, bodies and voices flattened on screens and above all, bodies of dead health workers and carers. Black bodies, brown bodies. Working-class bodies. Bodies not normally praised, now being celebrated.
We are learning a whole new etiquette of bodies. We swerve around each other, hop into the near-empty street, calculate distances at entrances to parks, avoid body contact, even eye contact, and keep a look out for those obliviously glued to their phones, whose lack of attention threatens to breach the two-metre rule. It’s odd and disconcerting and isn’t quite second nature.
Until the pandemic arrived, many of us were finding texting, email and Whatsapp more suitable to our speeded-up lives. But now we are coming to reuse the telephone, and to enjoy the sounds in our ears and the rhythm of conversation, instead of feeling rushed and interrupted. A few of my sessions as a psychoanalyst are now conducted on the phone but, for the most part, I am spending my time looking into a screen, and seeing faces rather than whole bodies. Until I learned to turn off the view of myself, I, like others, was disconcerted by the oddness of catching sight of myself – a view I don’t think we are meant to see.
Conversations in therapy defy many of the customs of social intercourse. There are silences, repetitions, reframings, links across time, reminiscences of fragments, rushes of emotion, shards of dreams, things told and then disavowed. There can be fidgeting or absolute stillness. These form the idiosyncratic and personal ambience between each therapeutic couple. As a therapist, I am also alert to how the dilemmas that beset the person or the couple I am seeing are brought to our relationship.
The conundrums that brought the person to seek therapy in the first place can be replayed right here. For example, a person fearful of intimacy can experience the therapy relationship or the therapist as too close. Someone else who worries they are too needy may be reluctant to show their longings directly to the therapist, although well able to talk about how things go wrong for them in other relationships. The therapy relationship and the sessions are our petri dish. The field of study is the human subject (and her, his or their ways of being able to develop and change).
The therapist works to understand an individual’s personal psychological grammar – to help the person take the risk of unlearning and then learning anew, finding ways to not be in so much hurt. So too with the body. Those with troubled bodies bring them to the session. They may sit too close, for example, or seem to be concave, or dress incongruously, as though presenting a different persona in each session. In the course of therapy, such an abject body experience can be addressed, and, in unlearning and then learning anew, the person finds a more comfortable way to sit in their body.
How is the dematerialisation of bodies affecting us and going to affect us? Me, my patients, you – all of us? For some of my patients, their screen or home is a prison. Their experience is full of woe and worry. Therapy keeps them just about on the border of sane, but it’s a sanity that hurts: isolation can maraud all of us as we miss the interactions, intimate or casual, that confirm our sense of our value, our place in our community, our work and the world.
Some of my clinical preoccupations centre on how we acquire a physical, corporeal sense of self. Although psychoanalysis is a theory of mind and body, its main emphasis has drifted to the development of the mind and its structures: what we call defences, and the relationship patterns we have absorbed. Bodies have been very much the bit player to the main drama of the mind, even when mental processes or disturbance have resulted in bodily symptoms such as eczema or a non-biologically induced paralysis. As therapists, we traditionally read back into the mind the troubles visited on the body, seeing them as the result of mental conflicts. And of course, they often are, but I have long been keen to understand body troubles and body difficulties in their own terms, and to build a theory about the development of the body.
Bodies have always been bound and marked by social rules. Different societies make different sense out of similar bodily actions or gestures. The variety of body adornment and transformations around the world, from rings around the neck to the recent upsurge in labial reductions and penis enlargements, has made it ever more apparent that the body is not simply the product of DNA. The body we inhabit develops within relationships to other bodies. Usually it is within the maternal orbit where, to take an obvious example, we first apprehend gender-based forms of comportment. When I grew up, being told to sit like a girl and not to climb trees were some of the ways we were treated differently to boys. Research across many cultures show that baby girls are weaned and potty-trained earlier, fed less at each feed, and held less, than boys. There may be no biological basis to this, but rather a social, unconscious basis that then informs how we personally experience our particular embodiment.
We have very few verified reports of humans growing up outside of human culture but the feral child Victor of Aveyron, who was discovered living wild in the woods of southern France in 1800, did not have body movements that were recognisably human. The body-to-body relationship that was foundational for him was with the bodies of the wolves he apparently grew up among. He seemingly mimicked their gait and moves, their posture and their vocalisations. Of course, we know this more familiarly, and less dramatically, from when youngsters develop their group identities by adopting the mannerisms of film actors or musicians.
Through screens, billboards and photoshopped images, we reduce the wide variety of bodily expression. It’s as though we are losing body diversity just as we are losing languages. The digitised, westernised body image predominates, and in the last two decades has spawned a cosmetic surgery industry worldwide – from leg-lengthening surgery using steel rods in China (now banned), to rhinoplasty in Iran (which has the highest rate of nose surgery per capita in the world) to double-eyelid surgery and jawbone reduction in South Korea. In the west, surgeons resculpt cheekbones, breasts and calves, and offer day procedures for facial ‘thread lifts’. Cosmetic surgery tourism hubs in Hungary, South Korea and Singapore were thriving until the lockdown.
One Chinese smartphone app allows the selfie-taker to adjust their portrait to bring it closer to a very specific standard of beauty known as wang hon lian, or “internet celebrity face”. It’s very popular: billions of wang hon lian images are uploaded every month.
The richest Europeans are not in tech, but in the business of beautifying bodies – the owners of fashion, luxury and cosmetics brands such as LVMH, L’Oreal and Zara. Increasing automation has led us to move from using our bodies to make things to turning our bodies the site and the product of our labour, through diet and exercise regimes, clothing and cosmetics. The surface body is meant to be on display.
Paradoxically, the sweating, smelling, holding, stroking body of the other becomes, for those socially distancing, too distant – while for others, such as those sharing a house with teenage boys, it’s all too present. All is on show for families and housemates, while all is hidden for those living alone during lockdown.
The experience of the body on FaceTime or Zoom contrasts with the pulsing, breathing, weeping, sighing, tired, achy or indeed springy and enthusiastic bodies we inhabit. We no longer have social communion in the flesh, the handshake or the hug, the pleasure of eating in a restaurant with a friend or lover while seated near strangers. Afraid of infection, for our protection, we collapse our social space.
During the second world war, the psychiatrist René Spitz studied orphan babies in care. He discovered that those closest to the nurses’ station thrived, while those at the end of the ward did not do so well. The difference was touch: the nurses would casually touch and interact with those closest to them, and this gave those infants the essential food for physical and psychological development. They absorbed the will to live. A decade later – in research now considered controversial for the way in which he removed baby monkeys from their mothers – the American psychologist Harry Harlow discovered that baby monkeys given ersatz mothers in the form of basic cloth puppets would find some crucial security and comfort even in this simulation of maternal touch; those baby monkeys deprived of any kind of maternal touch at all became highly disturbed, and many died.
Touch, feel and proximity are central to survival. Consider the genius of premature infants’ capacity to regulate their own and, extraordinarily, their parent’s body temperature, if they are held skin-to-skin in a pouch. The gaze – the search to be seen, to recognise and to influence the other – is also crucial to human subjectivity. In a fascinating video made by the developmental psychologist Edward Tronick, he instructs a mother playing with her baby to keep a still face and refrain from interacting with her infant for a minute or two. We observe as the infant girl seeks to engage the mother. When she is unable to, the baby collapses psychologically and physically until contact is restored. What is so shocking is how fast the collapse is.Trauma Therapy (EMDR)
I’ve been thinking of how impossibly difficult and challenging our quasi-dematerialised life through the Zoom screen is, whether chatting with friends or being in a meeting. Conflict and harmony become cartoonish as subtle gestures collapse and the conversations we have with our eyes are shut down.
Reading each other well enough is a new skill in the therapy room, too, for both people. By now we are used to the screens and the telephone, and the occasional technical blips. We are seeing a physical interior – a study, bedroom, shed or kitchen, and being surprised by an occasional child that floats in. We hear the suddenly hushed voice of someone not wanting their partner to get a drift of the conversation we are having. It illuminates aspects we didn’t see before. Is it better? No. Is it worse? Marginally. I miss noticing how people enter the therapy room – the subtle difference from the session before, or the way they may hold their face and body; above all, the animate body in the room. I suspect that I am more animated to make up for the loss of that precious physicality.
Former hostages Terry Waite, John McCarthy and Brian Keenan have all written and spoken eloquently about solitary confinement and their struggles to find a way through and back – or should I say forward – to familial and social life. It was tough. And although many of us are not self-isolating alone, unless one is able to do interesting or valued work during this period, or have enough people to hang out with, we can expect considerable psychological difficulties to follow as we come out of lockdown. How will we re-establish social interaction with other bodies? What kind of rhythms will we want and be able to have going forward?
Many have been ultra-busy with home schooling, working from home, managing three generations and so on. Time has bent and contracted in perplexing ways. Busyness has increased for some, while others, for whom slowing down is a foreign concept, have had idleness forced on them. Empty time feels alien – or at least did at the beginning. For many it has been an unexpected pleasure. No need to rush to social occasions. No need to dress. No need to get everything done and more. Being wanted, being needed, being in demand have been psychological supports that have melted away. Finding new ways to nourish one’s needs in this new reality – especially in the absence of touch and gaze, which we unknowingly rely upon to recognise ourselves – can be tricky.
Today, there is a frightened, wary, social body. A body that is tense, in which avoidance is the watchword. The covered face, whether by a hoodie or a veil, which formerly some found challenging, now offers reassurance. Indeed, many public places – from Eurostar trains to the streets of New York, Prague, Dubai, Havana and many more – now demand it. Meanwhile, much of society is now paying attention to bodies that had been scandalously overlooked. The bodies of working women, the carers who go in and out of the houses and homes of the people they look after. The faces of vast numbers of black, Asian and minority-ethnic bodies, particularly in the health service, who are finally being recognised for their value, and the shockingly disproportionate number of their losses.
Before Covid-19, the ruling party were happy to slash social and health funding, to put money into management in the NHS, and not into professional carers, doctors and nurses. Now society is waking up to the value of care and medical expertise that comes from the hospital floor – that is to say, from the doctors and nurses who are reorganising what occurs there. The people keeping society going in every sector – transport workers, small shopkeepers, workers in food production and delivery – are often first-generation immigrants. More people are seeing a more nuanced social landscape. The opportunity is here for reframing how we represent the social body. It is of necessity differently hued, and that needs acknowledging, as does the shame of our previous marginalising. Covid-19 is cleaning the lens, so we can see more clearly.
From the individual to the social body, and how it is being challenged by the pandemic, we turn to the corporate body – the body of state – and what we have been learning about how it has functioned. On 17 April, Prof Anthony Costello, a former director of the Institute for Global Health at UCL, told the select committee on health and social care that he feared Britain might have the highest number of deaths in Europe, which has now been confirmed. Costello had estimated 40,000 deaths; on 5 May the official UK death toll was just over 32,000, but the Financial Times reported the same day that the true figure had likely already surpassed Costello’s estimate. London and the north-west of England are showing higher rates of death than other regions, while according to the ONS, people in the most deprived areas of England and Wales are dying at twice the rate of the most affluent areas.
Costello argued for this figure because we were slow off the mark to take precautionary moves early on. He spoke to the chair of the committee, Jeremy Hunt, who has spent this period appearing to stress about the lack of testing, ventilators and PPE equipment. This is the same Hunt who, as the longest serving health secretary in British history, also had social care in his portfolio, and the pay of doctors, nurses and social care workers. Even more damningly, he was the minister in charge during Exercise Cygnus, the UK government’s drill to test our preparedness for a pandemic, carried out in 2016.
The full review of Exercise Cygnus has never been officially published, but leaks have revealed that it showed the UK’s health system and local authorities were woefully unprepared for such an eventuality. The exercise showed hospitals and mortuaries being quickly overwhelmed, and shortages of critical care beds, ventilators and personal protective equipment for hospital staff.
Cygnus, and other such exercises, are meant to show the government what they need to do to be prepared – which was not, as Hunt was doing, cutting beds. On 28 March of this year, when the Cygnus debacle came to light, we were told that the projections were not remedied because of worries that beds, ventilators and PPE would become outmoded or obsolete and that the government had worked on securing reliable supply chains. (As we have seen, in a pandemic, reliable supply chains become very quickly overwhelmed.) A 2018 Red Cross conference report on Cygnus and infectious diseases stated: “The financial and human cost of an outbreak can be staggering and early response reduces the cost.” Our government chose not to act.
Fund for Peace, the Washington-based NGO that publishes the annual Fragile States Index, lists criteria for a failed state. I think we have come dangerously close to fulfilling two of their criteria: the inability to provide public services for the poor, and the inability to interact with other states as a full member of the international community.
As these last months’ farcical developments show – the question about the independence of the Scientific Advisory Group for Emergencies (Sage), the alleged missing communications with the EU on PPE, the political decision not to cooperate with the EU, the posting out of tests without return envelopes, and the expired dates on PPE equipment – the government is in Fawlty Towers territory.
Plans for British companies to design new ventilator machines, detailed by the Financial Times, went belly up. Our government chose to source new ideas rather build to the existing plan under licence. Why, one must ask? Could it be Brexit hubris?
I don’t want to contrast the UK’s response with that of the EU, because the latter has not always covered itself in glory during the pandemic. The ethics of cooperation in Europe and the ethics of transparency and honesty have been mightily tested in the past months. Perhaps now though we can be encouraged by the joint project of the European Investment Banks and WHO to bolster global healthcare systems. Will the UK state be contributing? I think not. So much depends on the actions of citizens now to move things forward. In this light, it is encouraging to see the formation of a new independent panel of experts – a “rival” to Sage – led by the former UK government chief scientific adviser David King, whose deliberations are on YouTube for us to watch.
I am not sure how we characterise the following failure of the state, because it is in part the expression of public good: of the 750,000 people who signed up to volunteer to help the NHS, invited by the government, fewer than 100,000 have been deployed. As citizens, we want to contribute. This squandering of people’s generosity is disturbing. Fortunately, people such as Capt Tom Moore or the many making masks and contributing 3D printers keep on going. And the programme Feed NHS, in which the restaurant chain Leon and other chefs are prepping to feed patients, doctors, nurses, hospital porters and ambulance workers, is now in train. This voluntary work, in which groups of people self-organise, is outstanding, and yet it is in contrast to the inability of our state to mobilise those who wanted to help.
The Gates Foundation’s contributions to seven different vaccine programmes, and Twitter CEO Jack Dorsey’s donation of $1bn, are impressive. Will hedge funds in the UK such as Ruffer investment, which pocketed £2.4bn in March, or Somerset Capital (the fund Jacob Rees Mogg used to run) who see Covid-19 as a “once or twice in a generation” opportunity for investment, make a contribution, too?
There are several dozen UK-based hedge funds managing assets worth £1bn or more. Could the mood of the country be such that hedge fund investors and managers might be persuaded to donate some of their obscene profits to the coronavirus response or to sponsor migrants from beyond Europe (who work here as cleaners, carers, drivers), who do not earn the £30,000 currently demandedfor a work permit?
Covid is a sad story. It is also a story of resilience. The body of state has failed us. We need to grow up and recognise that. Covid-19 has exposed unforgivable systemic failure. In the years leading up to this, we’ve seen a reduction in the status of civil servants and a downgrading of health workers. We have seen teachers, doctors and academics hidebound in a managerial economy. At least it seems that micromanagement has been temporarily overturned in hospitals, thank goodness, because right now doctors and nurses need to be running the show.
And to return to our bodies – the live ones, so many devoid of touch and gaze, facing a long period of isolation, and frightened. How can I conclude?
In a way, I can’t. We are far from the other side of this crisis. Psychological therapies are going to have a huge part to play in the remaking of body and soul. I don’t much like the word trauma, because it has become so overused, but we are a society that is in trauma. A societal trauma gives opportunities for people to go through things together, rather than suffer alone, as long as we don’t bury or make light of what we have experienced and continue to experience. We will have to find new ways to live with our fears and discomforts, to overcome Covid-minted social phobias, with what we project on to other people’s bodies and the fears we have about our own vulnerabilities. We will need all the help we can get in reshaping our relationship to our own and each other’s bodies, to find a way to build bonds of attachment and respect.
What started with the dematerialisation of the individual body has now morphed into the dematerialisation of the body of state. The economist Joseph Stiglitz reminds us that, with the stripping back of the state under Ronald Reagan and Margaret Thatcher, we lost capacity. This needs to be addressed.
There is a lively debate from a range of economists on how to get to a more equitable economy. Moneyweek editor-in-chief Merryn Somerset Webb’s call for a sovereign wealth fund, with the government owning shares in bailed-out companies, is interesting, as is political economist Will Hutton’s idea of expanding the British Business Bank and the Future Fund. UCL economics professor Mariana Mazzucato insists that the state must invest in innovation.
We began trying to make a different kind of society after the second world war. We will have to do that again. Principally, we will need to recognise the contributions and the losses of the UK’s minority and working-class people, above all. Our governments have shamed themselves through creating divisions in society, particularly since austerity was imposed under David Cameron’s government. Now we have an unexpected chance to redress the divisive fallout of Brexit.
The impact of remote working and the need to balance domestic and work life, allied with dire warnings on mass unemployment, gives us an opportunity to write a social contract in which we divide work more fairly. At both ends of the pay scale, people overwork. The evidence for a more balanced relationship between work and home is compelling.
Since the crisis began, the outpourings of artists, musicians, programmers, cultural and scientific workers at all levels has been outstanding. The talent, the will, the desire is there to remake our world. The urgency is not in question. Globalism can’t simply be a celebration of “just-in-time” deliveries. It will need to be recast as mutuality – local and global mutuality – so that we learn from each other, including those who’ve been in lockdown in war zones.
Therapy under lockdown: 'I’m just as terrified as my patients are'
Our institutions will need to be rebuilt with transparency, with heart and by learning from the people who have been staffing them, not just the managers and owners. Doctors, nurses, carers and delivery people have things to say about how their institutions could be better run. The body politic and the politics of the bodies that make up our world must be reconfigured, and we need to start thinking about that now.
I conclude with Freud: “The aim of psychoanalysis is to turn hysteria into ordinary human unhappiness.” That is an accomplishment for an individual and for a society. We cannot escape unhappiness. It is constitutive of being human, just as are creativity, courage, ambition, attachment and love. Let’s embrace the complexity of what it means to be human in this time of sorrow as we think and feel our way to come out of this, wiser, humbler and more connected.
My ongoing exploration into therapy related topics.