Seeking psychotherapy under capitalism during a pandemic

Harris is a clinical psychologist in New York City.

To paraphrase Marx, a society’s mode of production — how workers relate to production and to each other — determines that society’s organization and development. To understand how and why a society can change, it is necessary to understand the way in which production occurs.

By the same token, a human being’s mode of relating to others, including their thought processes, is determined by the socioeconomic forces under which they were born and how they subsequently function. How a person is able to develop socially, economically and politically is determined by the conditions under which they grow up and continue to live their life. When there is an abrupt change in those conditions — as in a pandemic or war — it markedly changes a person’s perceptions and behavior, for better or worse. It may even lead many people to seek therapy.

U.S., Cuba: Different health care systems

In U.S. capitalist society, individuals must grapple with a crisis, such as the coronavirus pandemic on their own. Those who must seek help from therapists in the U.S. — which does not have free, universal health care — must take on the expenses or have the right type of health insurance. If workers are laid off, as during this pandemic, many lose their insurance. It’s up to the individual to seek and find a compatible therapist. During this quarantine, the therapist must be available by telephone or online teleconferencing.

Not everyone has the resources to obtain therapy, even those who desperately need help. Psychotherapy is part of the inadequate, costly, for-profit health care system in the U.S. — the only wealthy, industrially advanced country without universal health care. Therefore, it is out of reach for many. Or it becomes a major expense, cutting into required monthly expenses. Subsidized clinics are few, with demand far outpacing available services.

However, in a country like socialist Cuba, all medical care is free. The system is geared to fulfilling the needs of the people and not enriching capitalists who profit from the health care, insurance and pharmaceutical industries. The state provides the spectrum of health care services. Finding therapeutic help to cope with a crisis is not an individual’s problem, but the responsibility of the state’s health care system — and it’s free.

Cuba’s state also directs a countrywide response in a crisis, such as a hurricane or pandemic, in a centralized way, taking the entire population into account. It isn’t up to individuals to find their own way to health or safety.

In U.S., pandemic may limit progress

One of the main issues for people who seek psychotherapy is the need for emotional and material independence. An important part of that is developing relationships with their peers, having a sense of belonging in the world, in addition to their family, and expanding their ability to relate to others in an ever-broadening web of connections with other people.

In the midst of the COVID-19 pandemic, because of the urgent need to “shelter in place,” many people whose independence is still precarious — having just left home, being emotionally or physically unable to exist without support or unable to support themselves financially or even practically — are pulled to return to a home environment that in different ways may severely limit their moves toward independence and relatedness to others.

Some people may be in emotionally and/or physically abusive intimate relationships with a partner before the crisis and were figuring out whether and/or how to break up. With the onset of the COVID-19 epidemic, a person may feel like there is no place to go other than to remain in the abusive relationship.

Here are some examples of patterns showing how people who were pushed by the pandemic to a new level of consciousness have handled this difficult situation. The examples are not about actual people, but a compilation of patterns observed in the process of therapy.

The road to independence and activism

Bella, a young woman who has had numerous psychotic episodes, lived at home with her extremely possessive parents and younger siblings. She had finally secured a job as a cleaner in a Bronx hospital, and she was very proud of it. She was finally able to earn her own money and didn’t have to depend on her parents to support her. Even though she had to take three trains to get to the hospital from her home in Queens, she felt like it was a wonderful adventure to be working.

When the COVID-19 pandemic hit, the hospital didn’t issue personal protective equipment to Bella or her co-workers. She was less concerned about getting sick than she was about maintaining her newfound independence. She was young and didn’t think the virus would affect her. Also, she was beginning to develop a relationship with another employee at the hospital, and she didn’t want to interrupt it.

However, Bella’s mother, who had always been overprotective, urged her to stay at home. Her parents are over 60, and her brother is asthmatic. All of them are vulnerable, should they catch the virus. Bella responded with indignation. Her mother was doing what she had always done, taking away her independence under the guise of being protective, making her feel like a helpless child. She would lose her job if she didn’t go to work and her new relationship.

Bella’s therapist said in this case it was different. The COVID-19 virus can be spread by people who don’t become symptomatic but can still carry the disease to other people. Bella could bring the virus home to her family while never getting sick herself. What could she do to protect herself from catching or spreading the disease and still maintain her fragile independence? The answer lay in the most important factor in the development of independence and self-sufficiency.

Bella had to develop meaningful relationships with her peers, her co-workers. She had to find out what they were doing to protect themselves and get the hospital to provide personal protective equipment (PPE) for all its workers, as well as to organize physical distancing there. Bella took some sick days off and got on the internet. She knew the email addresses of some of her coworkers and began to ask questions.

One of the people Bella contacted was a licensed practical nurse whom she met on her lunch breaks. The nurse told her that some of the staff were getting together to protest that the administration was not providing sufficient PPE. She had never thought of protesting about working conditions. It seemed risky, but she was intrigued by it. In this way, her orientation shifted from resenting her mother to focusing on her friends to find the way out of this frightening dilemma. Bella became an active part of something meaningful.

Finding human connections on- and off-line

A reclusive adjunct English professor, Jane, lives with roommates, but feels alienated from them. She is preoccupied with her own depression, shyness and struggle to talk comfortably in social situations — or even one-to-one with her students. She is also discouraged about her lack of advancement and feelings of being ineffectual on the job.

Jane enjoys teaching her classes. but she is afraid to finish her dissertation, which is necessary to advance in her field. She haltingly relates to other faculty in her department. Jane has a few women friends, but is always worried they will reject her. Her relationships with men are similar. She is always worried about being rejected and doesn’t see the men she meets as people just like her.

Knowing there is a world beyond her personal concerns, Jane doesn’t know how to access it. She has been working on these issues in therapy. Her therapist encouraged her to reach out to her peers, despite her anxiety, and to tackle her half-finished dissertation. There was a suggestion that by dwelling on her shyness and depression, she was focusing in the wrong direction — inward instead of toward the people around her — and that was keeping her lonely.

When the coronavirus hit, Jane had to teach remotely from home. The therapist asked her how it was living 24/7 in close quarters with her roommates. Noticing that their apartment was rather bare and drab, she put up posters she had. Her roommates, offering their own decorations, helped her put them up.

Since shopping had become a challenge, they pooled their resources and began cooking and taking turns making the perilous trips to the supermarket. The roommates slowly began spending more time with each other, eating and watching TV together, instead of retreating to their separate rooms.

After adjusting to teaching via the internet, Jane discovered a number of forums, webinars and Zoom calls, including one given by the college where she taught. She mainly observed at first, not daring to ask questions. But after a week, she began to identify some people from her department whom she was mildly interested in knowing. After two weeks, she finally asked a question — if there was a separate call for adjuncts.

Facing the possibility of fewer classes to teach the next semester, Jane wondered how other adjuncts were handling the impending threat of unemployment. Without the pressure of being quarantined due to the virus, and the need to find human connections via Zoom calls, Jane’s outreach and interest in her roommates and colleagues might not have happened.

Developing friendships is key

Darcy explained that he was the outcast in his family from the beginning of his life — or at least as far back as he could remember: too skinny, too hyper and he had weird things popping out of his mouth. This situation continued after he graduated from college, had a stay in a halfway house, but returned home to “shelter in place” during the pandemic.

Darcy had learned to focus on his studies when growing up to avoid the hostile atmosphere around him. But he had succumbed to severe depression once he graduated and realized he had nowhere to go. After a brief hospitalization where he received therapy and medication, he went to the halfway house where he started working on getting a master’s degree and tentatively began to reach out to others socially. That ended with the pandemic. After the halfway house was forced to close, Darcy went home to once again encounter the same chronic derision he had endured during his childhood.

Darcy found a therapist in order to figure out how to survive emotionally and physically. The key to finding relief could not be just focusing on studying. It had to be in finding new relationships — even remotely, online or renewing and maintaining friendships that began in the hospital and the halfway house.

Darcy found that the halfway house offered online forums, so he joined them. He raised problems about how the halfway house was organized. Although he expected rebuffs, Darcy came up with ideas about how to improve the organization’s functioning. He wondered how he was viewed, but decided that enough people seemed to accept what he said, so he couldn’t be that bad.

This differed so much from how Darcy was treated at home that he was sure he was headed for a fall. But this acceptance felt so good he couldn’t stop. Again, after having experienced relatively positive regard in the hospital and in the halfway house, the enforced quarantine at home made the need for more friendly and productive relationships that much more urgent. And that prodded Darcy to make a stronger effort to become actively engaged socially and politically.

Working and finding allies

Diana is a social worker at a homeless shelter. She lives with her partner, Linda, in a middle-income project in Brooklyn. She caught the COVID-19 virus and was seriously ill for three weeks before beginning to recover. Before the epidemic started, she thought of breaking up with Linda, who was clingy and abusive.

Once Diana became ill, all thoughts of leaving Linda disappeared. After Diana recovered, Linda — who had been unable to maintain distance from Diana — also became ill, although with a slightly milder case. Diana focused on how she could participate effectively at work via Skype or other teleconferencing. She seemed resigned to her fate, at least until the next crisis arose. The hope in therapy was that when she got more involved with work, Diana would be motivated to find allies who could offer shelter or protection.

As a social worker, Diana encountered many women who became homeless because they left an abusive partner. She was aware of the network of hotlines and safehouses available to them. It is just a matter of time before Diana would have the opportunity and the motivation to seek such shelter for herself.

Solidarity: path to survival

These examples show that, given the new conditions under which people are living — a global pandemic, impending economic depression and massive unemployment — some can make the choice to move from old moods of depression and feelings of helplessness and self-revulsion to focus on other people and how they can share common problems and solve them if they work together.

In interpersonal psychological terms, the shift of a person’s perceptual framework from the childhood era to the juvenile era moves a person to be curious about other people and learn what they have in common. They can realize how to relate to others to achieve common goals and work in concert to get what they want while enjoying other people’s skills and strengths in the process. In the childhood era, a person is focused on the authority of the parents, how to please them and how to tailor their perceptions and thoughts to meet their parents’ approval. There is not a lot of room for broader personal or political change.

To make the shift from having a childhood orientation to a juvenile one, there has to be validation in some form which affirms that relating to other people is necessary and desirable. That validation can come from a teacher, therapist or group — or even from a country like Cuba. That socialist country shares its medical expertise with people all over the world, while promoting solidarity to battle the pandemic.

Spreading the idea that planning and working together in solidarity is the path to survival and human progress can work for countries as well as individual people.