Care of the Soul and COVID-19

Ronald W. Pies is a psychiatrist, bioethicist, and professor emeritus at SUNY and Tufts. His writings often tend to the philosophical, which keeps me reading his work and occasionally engaging with him in cross conversation between Prozac Monologues and PyschiatricTimes.com, where he served as editor-in-chief 2007-2010.

Pies' recent post is one such example where our respective disciplines come along side each other, Care of the Soul in the Time of COVID-19. He identifies five assaults on the soul made by the pandemic: impotence, grief, loneliness, mistrust, and displacement. While underlining that one solution will not work for all, he proposes cognitive therapy, gratitude, and the arts as strategies for healing.

Therapy and Spiritual Direction

As a physician, it is natural that Dr. Pies would write of problems and solutions. I too have been thinking about the larger implications of the COVID pandemic. However, I do less pastoral care these days. My thinking has been more in the realm of spiritual direction. Spiritual direction is as likely to trouble the mind as soothe it, raising questions to ponder rather than soothing manifestations of distress. So my care of the soul focuses on the questions that COVID raises about identity, values, and purpose. 

Identity

Stages of Grief and Climate Change

In 1969 Elizabeth Kubler Ross published On Death and Dying. It described the grief process of dying patients and how family and medical personnel could help them toward a good death.

You probably know what came to be called the stages: denial, anger, depression, bargaining, acceptance. They were never intended to describe a straight line process, more like a series of way stations to be visited on the way. They came from her work with people who were dying, and were part of the foundation of the Hospice movement, to take dying back out of the hospital where the focus is on preventing death, and put it on a more humane basis. We all die. Let's do it without the violence of extreme measures.

Kubler Ross has been on my mind lately, as it becomes clear that the planet is dying. We all are dying. But so are the polar bears, as a species, the black rhinos, the bees... And when Monsanto kills off what remains of the bees... We are facing the sixth mass extinction of the planet. Unlike the earlier five, this one is on us humans. And evidently we have eighteen months to turn it around.

No, that BBC report was written last month. Make that seventeen months. The rest of the planet is addressing that deadline, while the US is set to spend the last months we have to make a difference locked in our own coming storm. We have one last chance to prevent a white nationalist totalitarian regime. The issues are tied, fascism and climate change, since the regime is doubled down on a nineteenth century energy policy. So, there we have it. We are screwed.

I am seeing those stages play out in social media and every day interactions. How about you?

Denial

I don't mean the old white guys who have a financial interest in denying climate change. I mean the determined optimism of those who still believe in the last minute reprieve. "Science will solve it." Science did solve it, years ago. We ignored them.

Do you think maybe Marvel Comics has tapped into the denial zeitgeist? Our obsession with comic book heroes testifies to our continued expectation that just when the game appears lost, somebody else will save us. Maybe that girl from Norway...

Anger

Ouch - right? You don't have to read the nightly body count. Look no further than your Facebook feed.

Somebody started a thread with Birdcage gifs. Here was my contribution:

What I think I sound like on Facebook:

What I really sound like on Facebook:

Do you have people who pre-irritate you? I do. Before they open their mouths, I already feel irritated. Maybe we have eighteen - no, seventeen months on climate change. But have we already passed the tipping point on anger? Angry at all the angry people around us - how do we reverse that one?

Depression

A quarter of us in the US are on psychotropic meds. That doesn't count all the self-medicators out there. This is the golden day for legal marijuana.

Bargaining


I think this is what the straw fetish is about. We sit in our SUVs at the fast food drive-through, motors running, and berate the poor kid who handed us our beverage with a plastic straw. Like, if we give up our plastic straws, we will dodge the bullet.

Acceptance

In Kubler Ross's original idea, with acceptance comes peace. I don't really see any peace about the death of the planet out there, nor in here. The closest I come is acknowledgement. That's the word I substituted years ago in the Serenity Prayer, when acceptance carried just too much baggage. God, grant me the serenity to acknowledge what I cannot change.

But these predictions of demise are not for the short term. The seventeen month deadline is for the tipping point. After that, carbon levels will be so high there's only one direction to go. The melted polar caps don't freeze up again, (90° in Anchorage on the 4th of July this year), the icebergs disintegrate, releasing more carbon into the atmosphere, raising the temperature more rapidly, causing ocean levels to rise. Salt water is already infiltrating fresh water aquifers, destroying arable farm land and causing water shortages...

What with environmental refugees, starvation, and the inevitable military responses, civilization is finished thirty years from now. Some say twenty. The thing about these predictions, the only mistakes the predictors make is to predict we have more time than turns out to be the case.

Even so, in the face of environmental refugees, starvation, water shortages, and military intervention, twenty years is a long time to stand on one foot, pulling off that serenity thing about a good death.

We need another stage.

David Kessler, Kubler Ross's coauthor on a later book provides one in Finding Meaning: The Sixth Stage of Grief.

I walked into my therapist's office last week after a month's absence and caught her up. "The book is going great. If it weren't for my existential despair, my life would be terrific." This was pure gift to her. My issues are usually cognitive therapy issues. But she says she does existential therapy. "Maybe ultimately there is no meaning. Maybe you have to find your own."

Finding Meaning

Well, there's plenty of that going around. From Trump as the Second Coming to Paul Ryan's blatant embrace of Ayn I-don't-owe-anybody-anything Rand (he's a Catholic of all things!), to Spiritual-but-not-Religious, to tattoos, to My Family is Everything and the Only Thing, to...

I just took this photo on a walk which included a sample of CBD tincture (self-medicating) and a swing by my favorite shoe store. They're red! They're mine! What does it matter that my portfolio is predicted to carry me to my end-of-retirement date, when my end-of-retirement date is anticipated to be later than the end-of-civilization date? Life is short, buy shoes.

So I choose a meaning. The family of God. As we all go down the tubes, I want to go down together, loving my neighbor as myself, welcoming the stranger, protecting the widows and children. Not the new-fangled heretical Christianity. Give me that old-timed religion, the Biblical Judeo-Christian thing that the Muslims embrace, too. It's not about power. It has stood up to Pharaoh, to Caesar, to Hitler. It will stand up to what comes next.

Sounds nice, but it's not about being nice, is it. For at least two thousand years, choosing a meaning that goes deeper than the embrace of power, choosing to stand with the dispossessed, the meek in the language of Jesus, has given people something to die for. Not kill for. Die for. To pull that off is going to take the energy I have left, and more. It will take a community of people to support such a decision - to be willing to die. I don't know what you call it. In my shop we call it the Body of Christ. It will take the Body of Christ to be the Body of Christ, broken together. Together with our nonChristian sisters and brothers, too.

Damn, this ended up a sermon. Well, here's the bottom line. If we're all going to die, I don't want to be an asshole.

Captain Marvel image from pyramidinternational.com

Birdcage gifs from giphy.com and tenor.com

dove icon in the public domain

flair from Facebook.com

photo of shoes by author

Grief/Depression IV - Not the Same/Maybe Both

So a woman goes into the doctor's office, three weeks after her husband died. I got through the funeral just fine. But now I feel awful. There is this ten ton weight on my chest. I'm exhausted; I don't have the energy to wash the dishes. I'm trying to pack up my husband's things, and I am too weak to pick up his shoes. I can't eat. Sometimes I get hit so hard with this wave of anxiety, I think I'm going to throw up.

What are the chances the doctor will say, Of course you feel awful. These are all very natural symptoms of grief. You just need time. But if you still feel like this a month from now, call my nurse and set up an appointment. What are the chances the doctor will not pull out the stethoscope and listen to her chest?

Answer: It depends on whether the doctor is stupid.

Or a psychiatrist.

These are classic symptoms of heart disease. There is significant overlap between the symptoms of heart disease and the experience of grief. But there is no Bereavement Exclusion for a diagnosis of heart disease. Instead, family physicians and cardiologists take the time to examine whether the person presenting these symptoms may have both.