It is the beginning of January 2021. Moving from the sun-soaked solidarity of the first lockdown, the mood has turned with the weather and we find ourselves in the second winter of this pandemic. Still oscillating between fear and arrogance, obedience and rebellion; the wet and cold weather has delivered a catastrophe this country has not known since WWII. The pandemic took a turn for the worse when a new variant of the virus took hold and found its way to know us even better: the numbers of fatalities in the UK have now passed 100,000, even before January ended. During this altered time, life for many offers no mercy. Some of our NHS (National Health Service) staff wake up everyday thinking: “can I do my job today, what if it’s going to kill me?” In psychological terms, this moral transgression is known as “moral injury.” Moral injury-based problems will be one of the side effects of this pandemic when it finally abandons us and will ensure that the trail of guilt and shame will drag on for many years to come. Trauma therapists call this PTSD.
For one of my clients who is a dedicated NHS worker, but who suffers the consequences of extreme childhood abuse and dissociation, this moral injury did not apply. I will name her Sara. Since the beginning of the pandemic Sara has allied herself with “Conspiritualism”, claiming that this virus is a hoax; that the evil left is trying to trap us with a toxifying vaccine; and that meditation, taking natural remedies and vitamins are sufficient to immunise our bodies so that they can fight back any virus.
Now in her forties, Sara’s abuse has left her with many parts and two very well-functioning ANP’s who suffer amnesia and are not consciously aware of her many other parts of different ages, gender and functions. I have been seeing Sara for nearly three years and for the past year we’ve been having most of our sessions online. My relationship with her two ANP’s and some young parts is generally a good one. Although this pandemic caused great upset to the young parts who can’t see me face to face, the social distancing which Zoom sessions offer have been in parts useful. We managed to get in touch with parts who probably never attend the therapy room. They hide in her cupboard or stay in bed all day. Also, the steady progress we have made means that my countertransference is no longer foggy or sleepy and we are slowly acquainting ourselves with her system and teaching her to have better communication between parts.
At the beginning of January, Sara was offered the vaccine at her workplace but refused to take it. I tried negotiating with the parts who are “anti-establishment” and whose loyalty is to their abusive past which was mirrored in their extreme political views and hatred of mainstream media, but without much success. A week later, Sara turned up to our Zoom session looking somewhat pale and fatigued. In a nonchalant manner she announced that she had tested positive and had a sore throat and temperature. I responded with some concern and compassion and asked her if I could help in any way. With apparent irritation she replied: “No, I can’t stay in, I need to go for a walk”.
Feeling rattled, by her reaction I failed to notice the switch that had just taken place. With some panic I then exclaimed: “But you can’t!! You are carrying a contagious virus, and you will be at risk to yourself and others!”
Sara: I don’t care, I don’t have Covid, it’s her who has it!!
Me (still feeling disoriented): What do you mean, who is she?
Sara: Her, that useless one who goes to work!
Me: But you said you have a sore throat.
Sara: No, I don’t!
Me: So, she is positive, and you are negative?
Me: Can you please have a look at the phone, you can see it shows the positive test result.
Sara: I told you I don’t care and there is no way I’m going to stay indoors for ten days.
In my desperation I then said; “I am sorry to tell you this, but since you are all cohabiting one body, I believe that this part you are referring to is already infected with the virus. It’s really important that you all get some rest and stay indoors even if some of you don’t feel the soreness in your throat.”
A young part then appeared and said: “Ok we won’t go out only because you asked us not to.” At this stage in our journey, and during this existential crisis the compliance of the young child part was the best outcome I could hope for.
The kind of “Not Me” reaction the altered part expressed is an old adaptation when a part of the personality is subjectively experienced as a wholly separate person. Van der Hart et al. (2006) define this as a form of non-realisation when: “Survivors as ANP are often not able to fully be in the moment either because they are avoiding internal and external reminders of trauma, again resulting in difficulties with synthesis. When intrusions of traumatic memories (and Eps) occur, their ability to be present becomes more limited. When survivors can tolerate certain stimuli, such as feeling or memory or sight of someone who reminds them of their perpetrator, they will not be able to include these in their core and extended personification and presentification. Instead, these stimuli are avoided, and survivors will engage in substitute actions to continue the avoidance: this is nonrealisation.” (p. 161).
Kluft (1991), also sees this as “a delusion of separateness”. This delusion establishes the locus of initiative of the ‘separate self-state as outside the patient and outside their control (or any conscious effort to know what that self-state is about).
Enactments between therapist and severely traumatised clients are complex and multi-layered too. If both therapist and client get triggered and dissociate, witnessing between self-states is no longer possible. The seriousness of the situation, and the escalating number of fatalities in the UK, for sure activated my own fear system and I am not sure if my response was a good one. However, I felt the need to respond with some urgency outside the ordinary boundaries to ensure that Sara’s threatening parts and the activation of her “delusion of separateness” wouldn’t take over. I also offered to see her every day during her ten days of quarantine. This felt very containing to every part in Sara’s fragmented system and gave us more time for negotiation which proved to be rewarding. By the end of the ten days, Sara’s ANPs and other parts were able to fully acknowledge the existence of the Corona virus and its impact on her weakened body.
The uncertainty this virus has made us face, is difficult for all. There is a limit to how much one can endure, therefore, some will seek control through observing tighter rules, whilst others will stage conspiracies to break those rules and flourish within their own mythological development. Be it secure or insecure, it is in times of crisis when we turn to the familiar, often an attachment figure, a place or a situation. The basic human behaviour of attachment can enlighten and help explain why threats generally can lead to a regressive behaviour, in particular for those who suffered the most. It is the presence of an empathic and understanding human being that can fill the void of threat and allow negotiation to replace fear. In the words of Philip Bromberg (2011):
“When patients are unable to contain an experience of intrapsychic conflict, the immediate goal is to use the therapeutic relationship to help them turn self-experience into something more than islands of “truth, to help them become able to ‘stand in the spaces’ between self-states, so that reliance on the protection of dissociation is replaced by the capacity to feel internal conflict as bearable.” (p. 50)
Bromberg, M.P. (2011). The Shadow of the Tsunami and the Growth of the Relational Mind. New York: Routledge.
Kluft, R.P. (1991). Multiple Personality Disorder. American Psychiatric press Review of Psychiatry, 10, 161-188.
Van der Hart, O., Nijenhuis E.R.S., & Steele, K. (2006) The Haunted Self. New York, London: Norton.