I Feel Okay

 

“I realized the oddest thing this week,” Anne begins, her voice fairly upbeat as she speaks into the telephone. “I’ve been feeling okay.”

“That’s terrific, Anne,” I say excitedly.

“Yeah, I’ve been talking to you for how many years? And this is probably the first time I’ve ever said I feel okay. I can’t figure out why. Nothing has changed. I’m stuck indoors like everyone else. Our Covid numbers are spiking, I’m as terrified as ever of getting the virus and yet I’m okay.”

Anne is correct. I have been speaking with her for a number of years and this is probably the first time she has not described herself as depressed, anxious and isolated. We began working in person when she relocated to Florida to take care of her aging and always demanding mother, a long and arduous process that called upon all the strength Anne could muster and all the support I could give. After her mother died, Anne returned to New York, saying it felt like home, although she had neither friends nor career to return to. She did, however, now have sufficient money to live comfortably whether or not she could find a career path commensurate with her intelligence and education, leaving behind her unsuccessful attempts in retail or restaurants.

“What are your thoughts?” I ask.

“I don’t know. I’ve done the same thing these past several weeks as I’ve done for months, or even years, and I feel strangely content. No despair, no pressure. Of course I haven’t had any pressure for a while, not since my Mom died.”

“Except for the pressure you put on yourself.”

“That’s true.” Pause. “I still feel I should figure out what to do with the rest of my life. I should be looking at various career possibilities, seeing what piques my interest. But I guess I know what the reality is with Covid. New York is decimated. There are thousands and thousands of people unemployed, stores are boarded up. No one is going to hire a 52 year old woman who has probably never held a job for more than a year. I also feel I should go back to my painting. I was pretty good at it. Why don’t I spend my very excessive amount of free time painting again? I should. But I don’t.”

“So you’re still putting pressure on yourself.”

“Yes” Pause. “And I do still hear your voice telling me I should be spending more time with people. But of course everyone is told not to spend time with people these days. But I know you’d still be telling me I should at least reach out to my sort-of friends by phone.”

“You still feel pressure from both yourself and me, but you feel different, calmer, less despairing.”

“Yes.”

“And you don’t feel isolated?”

“Everyone feels isolated.

“Maybe that’s comforting.”

“What’s comforting?”

“That everyone feels isolated.”

“That’s a good point. I don’t have to feel like such a freak.” Pause. “Yeah, that’s right. Usually this time of year would be the worst. Thanksgiving in November, Christmas and New Year’s in December. Everyone running around buying food and presents and looking forward to seeing family and friends. And then there’s me. Sitting at home stuffing myself with junk food and wondering if I should kill myself. But not this year, this year everyone’s in the same boat as me. I know they still have these ridiculous TV commercials with people sitting around a big table together or drinking themselves sick at parties, but now they look exactly like that – ridiculous. No one should be doing that this year. Everyone should be doing exactly what I’m doing, sitting home alone, no one else there. Yes, it’s a tremendous relief. That’s exactly why I feel okay.”

“Where do I fit in?” I ask.

“You’re my one exception. You’re here. But of course you’re not here. You’re thousands of miles away.”

“And that means what for you?”

“Actually makes me feel a little sad. But not too much, because I know even if you were next door we’d be meeting just as we are now, on the telephone. Yes, that makes me feel better immediately. So I guess that’s another thing Covid has done for me – made me feel less like a freak and made our distance feel less significance. No wonder I feel better.”

Anne may feel better, but I’m left feeling sad, both for the sadness she likely feels underneath her “better,” as well as for the isolation she wears as a protective shield, unable to breach the chasm between herself and others. Covid will eventually end and unless we are able to breach that chasm she will return to feeling like a freak, the forever outsider longing to be part of the lives she only imagines.  

Tag words: Psychotherapy, mental health, patient-therapist relationship, projective identification, isolation, sadness, despair, aloneness, Covid19.

Alone Together

“I’m feeling so horribly sad,” Marion says, her sadness apparent from her voice which I hear remotely on my cell phone. “I feel sad for the country, sad for the world, sad for all the people who are losing their lives every day.”

Pause. “But mostly, I must admit, I feel sad for me. I mean, I’m grateful that everyone I know personally is well, that I haven’t had to deal with a loved one dying without being able to say good-bye… But I feel so alone, which is ridiculous. I know I’m not alone. Arnie is here with me as always. I get to FaceTime with my daughter and grandchildren almost every day – although how they’re all surviving in that apartment I have no idea. And with my son and his husband at least once a week. They’re actually doing very well, working from home and enjoying what they call a second honeymoon.”

Silence.

If I were I in my office with Marion I know I would wait for her to continue before I speak. But remotely I’m concerned that the silence will increase her feeling of aloneness. “And you feel sad because…?” I ask.

She sighs. “Arnie and I have no relationship. None. I mean I know we’ve been together for 30 years. I don’t expect us to be falling over each other like my son and his husband. But something, something…” Pause. “We sleep in the same bed. We get up in the morning, have breakfast, each of us focused on our iPads, barely speaking. Then he goes into the living room to watch endless news shows about the virus. I sometimes take a walk, then head for the bedroom to watch old movies or read or sometimes talk on the phone. I wish we at least had a dog, but of course they don’t allow them in our condo.”

Pause.

“Before at least I got to get out, had a change of scenery. I played cards, had lunch with my girlfriends, went to a movie. When I worked that was entirely different. You know, it’s sometimes hard to believe that Arnie and I were both teachers, that we had interesting lives, interesting things to say to each other. Now there’s nothing. Nothing. Emptiness.”

“And feeling alone with someone feels worse than being alone by yourself.”

“That’s definitely true.”

“You said that you and Arnie sleep in the same bed. Do you ever have sex?”

“I’d be hard pressed to remember the last time we had sex.”

“Do you miss it?”

“Sex has been so perfunctory for so many years it’s hard to say I miss it. I do miss cuddling. I miss the occasional kiss, holding hands, caring about each other. Now there’s literally nothing. The absence feels so bleak. And it’s mirrored in all those pictures of cities without people. Or even here – shuttered tennis courts, golf courses, emptiness.”

“Have you talked with Arnie about your feelings?”

“I’ve tried, maybe not enough, but I’ve tried. I tried sitting next to him on the couch, putting my hand on his knee, asking him something about what’s on the TV. Nothing.”

“But have you told him about your feeling of emptiness, of aloneness?”

“I can’t do that.”

“Why?” I ask.

Pause. “You know what I thought of? I thought of being a child, maybe 10, 11 I’m not sure. It was a rainy, dreary day. Must have been a weekend since I wasn’t in school. I was bored. I went to my mother to see if she wanted to play a game, but she was on the phone and put her finger on her lips and motioned me away. So I went to my father just to be with him. I knew he wouldn’t want to play a game. But he was reading the paper, looked at me annoyed and shooed me away. I learned never to ask, just to wait and see if someone will be there for me.”

“We’ve talked previously, Marion, about your unconsciously choosing a man like your father, but today I’m wondering about something else. What is it that you feel, you, the adult Marion, if you think about telling Arnie what you’re feeling?”

“I can’t.”

“But what is it that you feel?”

“Uncomfortable. Vulnerable. Maybe embarrassed. Like I’m not supposed to have feelings. Maybe like I shouldn’t need anything from anyone.”

“Like you shouldn’t need anything from anyone. I think that’s a very important statement, Marion. I think you’re saying that a long time ago you withdrew from your own needs, that you walled off those needs and locked them in a room somewhere deep inside you. And what you’re left with is a feeling of profound aloneness.”

“That feels right. But what do I do about it?”

“I think we have to start looking for the keys that will help us unlock that door, so we can find the sad, vulnerable child who reached out to her parents that dreary day.”

Welcome Back

Annette smiles wanly when I open the waiting room door, walks slowly into my office, and lowers herself gently into her usual chair.

“Welcome back,” she says with little enthusiasm.

“Thank you,” I reply, surprised by Annette’s distance and reserve. Although this was the Annette who began therapy with me many years ago, our close enduring relationship had allowed her to deal with her childhood sexual abuse and to transform into a warm, open, engaged woman. Now forty-five, she worked as a para-legal and had a full, satisfying life. Although she never married, she had several long-term relationships and a network of close friends. She was usually especially glad to see me after my return from vacation, eager to catch me up on her life.

After a brief silence I ask, “What’s wrong, Annette?”

“I have some really bad news,” she says, her voice barely audible. “I have metastatic colon cancer.”

My eyes widen, tears immediately filling them. “Oh Annette,” I say. “I’m so, so sorry. When did you find out?” I was only gone two weeks I think to myself, aware that I feel guilty I wasn’t here for her.

“Just yesterday. I guess I’m still in shock. I wasn’t feeling well, had some bloating, discomfort. I wasn’t hungry which, as you know, is unusual for me. I thought maybe it was just my usual stomach stuff, but I went to my GI doctor. He examined me and suggested a colonoscopy and a CAT Scan. I was too happy about that. And then the diagnosis, cancer. They want to start chemo. I don’t know. I don’t know what my chances are and if I’m going to die anyway, I’d rather not prolong the agony.”

I’m overwhelmed by sadness, sad for this woman who fought so hard in her therapy to get through the pain of her past, only to now be forced to confront a dire illness and the possibility of death. My own losses flash in front of me as well, my husband to metastatic prostate cancer, numerous friends to pancreatic cancer, liver cancer, breast cancer. The list seems unending.

“I’m sorry, Annette,” I say. “I know I’m not being helpful to you.”

There again is her wan smile. “No, you are. I can see how much you’re affected by my news. That means a lot to me. I know you care for me. I know I’m not just one in a long line of patients.”

“We’ve worked together a time long, Annette. Of course I care about you. And I’ll help you through this however best I can.”

“Will you support whatever decision I make about whether or not to get chemo?”

“I will, but there’s a “but” to that statement. I want you to be sure you’ve explored all your options and know what the doctors think of your chances.”

“I am going to see an oncologist.”

“Good. I’m glad. And I also think you need to give yourself some time. You just found this out yesterday. It’s overwhelming. It’s overwhelming to me, it must be more than overwhelming for you.”

“You’re the first person I told.”

“You didn’t call any of your friends?” I ask, surprised.

“No. I knew I’d see you today. I was afraid if I told anyone I’d totally fall apart. I called in sick to work. I couldn’t bear telling everyone there and I didn’t know if I could fake it. They know I haven’t been feeling well.”

“Do you feel you can tell your friends now?”

“I don’t know. I’ll see.”

“Annette, does this feel like part of the abuse all over again? Like an unwanted, foreign thing invading your body?”

“Oh my God, I hadn’t thought of that! But it’s true. I mean I know it’s not the same thing, but it does kind of feel that way. How did you think of that?”

“I guess because today you’re more like the self I knew when we first started seeing each other – removed, defended, isolating. I know it could be shock, but for you I thought it might be more. And it’s not only the cancer itself, but all the tests you had to take and will continue to have to take. So we’ll need to be sure that your decision about treatment isn’t contaminated by your desire to avoid what might feel like more abuse.”

“You’re right. I wouldn’t want that bastard to destroy me in the end.”

“I wouldn’t want that either. Go see the oncologist, tell some of your friends and hopefully you’ll have  time to decide what to do.”

“See you Thursday.”

“See you Thursday,” I repeat, aware of the now increasing importance of time. 

Why Am I Coming?

“Why am I coming here?” Albert says as soon as he sits down. A depressed, distanced 58 year old man I have seen for two months, Albert is a difficult person to relate to.

He continues. “Nothing’s going to change. I’m never going to find a woman to be with. My two sons are going to continue ignoring me. I’ll never have friends and if I do they’ll always want something from me. It’s never going to change.”

Aware of feeling some anger at this litany of complaints I ask, “Do you feel angry when you say all that? Do you feel angry at me for not being able to make those things change?”

“What’s the point of being angry? They’re just not going to change.”

My anger inches upward. “Anger doesn’t necessarily have a point. It’s something you feel. Are you aware of feeling angry with me if I can’t help you change what you want changed?”

Albert shrugs. “This isn’t getting us anywhere.”

I have to agree. Time to change course.

“You’re right, Albert, I can’t bring women or friends into your life. I can’t change how your sons treat you. But are there things inside you you’d like to change? Things that perhaps make it more difficult for you to relate to people or for them to relate to you.”  

“What kinds of things?”

“Well, you don’t seem to present yourself as someone who’s warm and friendly. You seem aloof, removed, perhaps angry, suspicious.”

“I have reason to be suspicious. When you make the kind of money I’ve made you have to know there are all kinds of gold-diggers out there. It’s not like my ex-wife didn’t take me to the cleaners. And my sons were always hitting me up for money. That’s all I was good for as far as they were concerned.”

“I’m not saying you don’t have reason to be suspicious or that you haven’t been taken advantage of, but I wonder if now you don’t use those reasons as an excuse, an excuse to keep yourself away from people, an excuse to protect yourself from being hurt, an excuse so that you don’t have to be vulnerable.”

“Damn right! Why would I want to be vulnerable?”

Feeling as though I am hitting my head against a brick wall, I say, “Because unless you’re vulnerable, unless you allow yourself to get close to people you live a very lonely, isolated life.”

“That’s how it’s always been,” Albert says, some of the edge gone from his voice.

Taking some hope from this change in voice tone, I say, “Tell me how it always was.”

“I already told you. I grew up in the middle of nowhere, a farm in Iowa for God’s sake, with parents who barely spoke English. I wore these clothes my mother made me because we were dirt poor, got laughed at school, did horribly, played hooky. It’s a miracle I ever got through. But I showed them. I showed them all. I made it bigger than all of them put together!”

Albert is back into his anger, the brief softer quality, gone. This time, however, I find myself feeling sad rather than angry. “Albert, for a minute, when I first brought up your living a lonely, isolated life, you seemed to soften just a bit, perhaps to be more aware of your sadness, but then as you talked about the deprivation and pain of your childhood, you went back into your anger.”

“So?”

“Well, that may be the question you need to answer, Albert. When you say, why should you come here, my answer is that you need to come here so that you can work on getting underneath some of your angry defensiveness to the sadder, more vulnerable person underneath. But that’s something you have to decide if you want to do. Do I think if we worked on that and you could find that more vulnerable person underneath that you would have a more fulfilling life? Yes, I do. But, again, that’s something you have to decide.”

After a few moments of silence, Albert says, “I don’t know.”

“I believe you,” I reply. “I imagine you feel quite torn. Your defensive anger has in many ways worked effectively for you for a lot of years. We can see how it goes. I know I said you have to decide, but it’s really not a decision. It’s more of a process, a process that ebbs and flows and we’ll ebb and flow along with it.”